Applied Behavior Analysis: Current Topics

Goal: To become a living, breathing functional behavior assessment.

2008-10-07T21:09:00.003-05:00

Functional behavior assessment (FBA) often carries a mysterious aura. Many professionals have an idea about FBA, think that they basically know what it is, but don't know how to begin to conduct an FBA, and nor do they want to. My goal in my consultation and teaching is to de-mystify functional behavior assessment. Teachers should become walking, living, breathing functional behavior assessors. FBA should not be something that is always formally conducted; rather, we need to keep the key questions of FBA constantly available to us and become fluent with asking ourselves these questions, so that when we observe a behavior, we can fluently functionally assess the behavior on the spot.

In our classrooms and homes, a full functional behavior assessment is not always possible. But it is important for teachers and therapists to learn to ask ourselves the key FBA questions to try and identify what is going on in order to inform intervention. So, some questions to keep on your mind....always...

1. Why do I think he is engaging in this behavior? A simple question, but at the crux of FBA. Function=Why. Why is the child engaging in this behavior? To escape the task? To get something he wants? To get my attention? Breaking it down and asking the question in the moment, helps us to think analytically about the behavior not only will help inform intervention, but helps the teacher take a step back and see the behavior for what it is, communicative, and not personal.

2. Is there a setting that appears to occasion this behavior? Does it occur more during certain activities? AFter a transition? When leaving a preferred activity for a non-preferred activity? When there are more or less people in the room? After a long weekend or break? Identifying patterns in when the problem behavior occurs informs intervention as we can then develop a plan to work within that setting or activity. For example, if we identify that a problem behavior occurs during writing workshop, we can target writing workshop by a) breaking down the activities into smaller mini-activities within he workshop to make it more manageable, b) we can pair the environment positively and use the child's preferences incorporated into the workshop, c) we can make sure that writing workshop does NOT follow a preferred activity, but rather is followed by a preferred activity to act as a natural reinforcer, d) provide additional support during this activity, e) teach functional communication to replace the inappropriate behavior in this context.

3. Is there a consistent antecedent to the behavior? Meaning, what usually happens just before the behavior? Identifying this pattern may also help to inform intervention.

4. Is there a consistent consequence to this behavior? What usually happens after the behavior that may be maintaining the behavior? Is my behavior as a teacher maintaining the inappropriate behavior? How can I change my behavior while teaching my student/child a new behavior.

These questions should be asked of ourselves as teachers with fluency when observing behavior. This is not to say that formal functional behavior assessment is not necessary; however it isn't always feasible. Working in a busy and active classroom, it isn't possible for a teacher to stop, complete every data sheet necessary, and observe behavior taking note of antecedents and consequences. It is however possible, with practice, to think FBA all the time.

Off Topic: My Baby Girl

2008-07-05T11:44:00.002-05:00

Hi Everyone,

I haven't posted in several months, but haven't forgotten the blog. I had a baby girl on April 14th. Her name is Ioanna (joanna but with an "I" instead of a "J") and she was born 5 pounds 15 ounces. She is now almost 12 weeks, smiling, laughing and giggling and is a joy.

I am however amazed at the social skills that she exhibits at this young age. Sustained attention for long periods of time, referencing, babbling, reciprocal babbling, and some precursors to joint attention. At 2.5 months, she is exhibiting these precursors to spoken language and it is amazing to watch.

As a behaviorist, it is also interesting to see how she has shaped my behavior and how my perspectives on some strategies have shifted somewhat. I wonder if as she grows, I would change as an ABA therapist, and if some of the techniques I have employed in the past (waiting out a tantrum, crying, etc.) would be acceptable now. We'll see.

I'll get back to posting soon.

Angela

Stereotypy in Children with and without Autism

2008-03-23T11:38:00.002-05:00

A research review by Michelle Rodgers (CUNY Queens College)

Authors: MacDonald, R., Green, G., Mansfield, R., Geckeler, A., Gardenier, N., Anderson, J., Holcomb, W., & Sanchez, J.

Title: Stereotypy in young children with autism and typically developing children

Purpose of this study: The purpose of this study was to compare motor and vocal stereotypy in 2-,3-, and 4-year old children with autism and typically developing children within the same age group.

Participants: A total of 60 children participated. 30 were diagnosed with autism or PDD-NOS and 30 were considered typical. Each group was broken up into three subgroups, 2-, 3-, and 4-year olds, each with ten children.

Settings: The setting was a small testing room at the New England Center for Children. The testing room had books and toys as well as a table and chairs.

Target behaviors: The behaviors that were measured were vocal and motor stereotypy across the two groups of children and across the 3 age groups. Some examples of vocal stereotypy were: non-contextual giggling, vocalizing non-recognizable words and echolalia. Examples of motor stereotypy were rocking, hand flapping, tapping objects, more than 2 times in a row, spinning, and finger flicking.

Procedure: Children were administered portions of the NECC Early Core Skills Assessment battery. These components covered motor and vocal imitation, matching, receptive and expressive communication, as well as instruction-following skills. Only a ten minute sample of the assessment was used, even though each student was given the entire battery. During the play portion, children were told to play with the toys but were allowed to move around the whole testing room. They were not prompted after the first directions were given. During the structured component, the children were administered tests for motor imitation, vocal imitation, and social questions. If the children engaged in stereotypy, it was not redirected.

Results: The results indicated that as the age increased for children with PDD-NOS, the mean percent duration of total stereotypy (vocal and motor) increased from 12% at 2-years old, 23% at 3 years old, and 39% at 4 years old. For typically developing children, the mean percent duration of total stereotypy decreased from 5% at 2 years old, to 3% at 3 years old and 2% at 4 years old. The children with PDD-NOS started with a higher mean percent duration than the typically developing students. The 4 year-olds with PDD-NOS displayed even higher rates of stereotypy than the 2 year-olds.

Implications: The study has several implications.

First, the optimal age for early intervention would be 2 years-old or earlier. Stereotypy is still relatively low at 2, that there may be more opportunities to teach appropriate behavior without having to compete with stereotypy.

Also, the fact that the four-year olds had higher rates of stereotypy implies that more should be done to limit the practice of stereotypy so that there is not much of a reinforcement history attached to these behaviors.

The types of stereotypy observed in the typical children and the children with PDD-NOS were also of interest. Children with autism tended to emit repetitive noises or non-contextual phrases, while rarely making eye contact. Typically developing children emitted contextually appropriate and identifiable words as well as made eye contact.

Stereotypy and social engagement : A Research Review

2008-03-11T07:10:00.002-05:00

A research review by Jennifer Morrison (CUNY Queens College).

Lee, S., Odom, S. L., & Loftin, R. (2007). Social engagement with peers and stereotypic behavior of children with autism. Journal of Positive Behavior Interventions, 9, 67 – 79.

Purpose of the study: The relationship of social engagement and stereotypic behavior for children with autism, which looked particularly at if increased social engagement lead to decreases in stereotypic behavior, and finally if these decreases in stereotypic behavior generalized to other settings as well.

Participants: Three children diagnosed with autism who engaged in frequent stereotypic behavior. One child was 8 yrs old with moderate to severe mental retardation with severe delays in language. Another child was 7 hrs old and engaged in a variety of oral/vocal stereotypy and also would sometimes engage in self-injurious behavior to himself and also others. The other boy was 9 years old and had profound mental retardation; he could follow simple verbal commands from adults but also engaged in high rates of vocal and motor stereotypy. In addition to the three children diagnosed with autism, 12 (6 pairs) of children without disabilities also participated that were all in third grade classes that the three children that were part of the study were in.

Setting: The study was done in a 5 m x 4 play area in a special education classroom. The area was full of several different types of toys and objects that they could play with.

Target Behaviors: The behaviors that were mainly investigated in this study were initiations with a peer or stereotypic behavior. Initiations were defined as: any vocal/verbal or gestural behavior that a participant/peer directed to another peer and that was not preceded by a socially oriented behavior from that peer. Stereotypic behavior was defined as topographically similar behaviors that were performed repetitively. These could include vocal which was when children used their mouths or made vocalizations or sounds. Motor stereotypy was defined as when children used any of their body parts except vocal with or without manipulating objects (eg finger flipping, wiggling fingers, banging head, etc.)

Procedure: The experimenters used a multiple baseline across participants and settings. After the first participant had a stable baseline they then introduced the intervention. Once the first participant reached stable responding at intervention, the intervention was introduced for the next participant…so on. During the baseline phase, each child with autism was observed during structured free-play sessions with two peer buddies. No instructions were given to the children and lasted approximately 5 minutes. During training, the trainer taught the peers four social skills concepts (sharing, suggesting play ideas, assisting and being affectionate). Each training session began with a verbal discussion of the importance of playing with friends and/or a review of the previous day’s play. After this the teacher then modeled appropriate and inappropriate responses. In the using skills intervention the teacher reminded the peer to use the skills they had learned to get their friend to play, and the peer then got the child to play in a structured activity with them.

Results: During baseline, all three children did not engage with peers at all in any type of play situation. After training with peers, the mean percentage of social engagement increased to, 69%, 79%, and 56% for all three children. More importantly, this behavior continued through the reimplementation period and also for generalization probe trials with children that were not trained. At the same time, the participants’ engagement was more variable during the generalization phase which took place at snack time. In addition, during baseline each of these three children engaged in high rates of stereotypy (87%, 47%, and 89% respectively). When the peer initiation intervention was introduced not only was social engagement increased but stereotypic behavior decreased in all three children.

Implications: This study had several important findings. First of all, this study showed the importance of training peers to initiate social interactions with children diagnosed with autism. This study also showed how effective training with a peer model can be in increasing social engagement in a child on the autism spectrum. More importantly it was shown that the percent of self-stimulatory behavior also decreased with all three children. This shows the importance of the relationship of a set of social skills in comparison to stereotypy. If a child is engaging in a conversation with another child, this gives them less of a chance to engage in vocal stereotypy especially. The other really nice thing about this study is that it was naturally done with peers of the children that were their age. This study ultimately shows the importance of peer modeling and peer assistance to children diagnosed on the autism spectrum. One thing I thought was a strong point of this study was that they also used children that were not on the high functioning side of the autism spectrum. When reading studies similar to this, there are a lot of studies done with children with Asperger’s or related symptomology, but very little with children with more severe deficits and higher rates of self-stimulatory behavior.

Research Review: Physical exercise as a Reinforcer

2008-02-24T20:37:00.002-05:00

Research Review by Michelle Rodgers (CUNY Queens College)

Azrin, N.H., Ehle, C.T., & Beaumont, A.L. (2006). Physical exercise as a reinforcer to promote calmness of an ADHD child. Behavior Modification, 30, 564-570.

Authors: Azrin, N.H., Ehle, C.T., &Beaumont, A.L.

Title: Physical exercise as a reinforcer to promote calmness of an ADHD child

Purpose of this study: This study had several purposes. One purpose was to determine if scheduled exercise could serve as a reinforcer for a child remaining calm for a certain period of time. Next, the authors wanted to determine if the exercise would result in calmness even if it wasn’t based on being a contingent reinforcer, if specific praise could result in calmness, or whether contingency was necessary to promote calmness.

Participants: The subject was a 4 year old boy that was diagnosed with autism and ADHD.

Settings: During baseline, the child was observed in his classroom setting. During the procedural component, the child was observed in a separate roomTarget behaviors: Calmness was the target behavior and was defined as sitting calmly and attentively and looking at the assistant.

Procedure: The procedure had several components. These procedures were given on separate days and alternated over the course of 5 days. The reinforcer would be 1 minute of play in an outside playground that contained gymnastic equipment and other climbing structures. The child would engage in activity for the full time and would not be prompted.

Shaping was the first component and the purpose was to attempt for the child to display calmness according to the definition. The time for the child to sit calmly increased from 1 second and after several trials eventually reached 60 seconds. Specific verbal praise was given throughout the session as well as after each successful session. After each successful session, the child was allowed to play.

The descriptive praise was the component in which only specific praise was given for the target behavior and the playground was not used as a reinforcer.

The noncontingent reinforcement phase allowed the child to use the playground every 60 seconds regardless of calmness and no praise was given.

The reconditioning phase allowed the child 60 seconds of playground activity contingent on 60 seconds of calm behavior. Descriptive praise was included at the end of each successful session.

The baseline component was the phase in which the playground was not given as a reinforcer and no descriptive praise was given. The child was seated in the chair and was returned to it when he arose from it.

Results: Prior to the intervention, the child was out of his seat for 100% of the time. The shaping and reconditioning phases had the most dramatic results. In these two phases the child was able to display 60 seconds of attentiveness which lasted for 50 minutes of the session. Descriptive praise, noncontingent play, and the baseline phase resulted in about 3 to 5 seconds of calm behavior.

Implications: Although this study was conducted on only one boy, it is interesting to see that vigorous activity served as a potent reinforcer. For children with ADHD, engaging in exercise at scheduled times may allow for more attentive behavior in the classroom. While the teachers noted how calm the boy was during the intervention, he was in a separate room. It would be interesting to see how attentive he would be in the classroom if he was able to “work” towards use of the playground as a reinforcer. This study offers another possible reinforcer that could be paired with the usual token economy that is often implemented in the classroom. A feasible schedule would need to be worked out to obtain maximum attentiveness in the classroom, while appropriately allowing for playground activity time.

Research Review: Scripted peer tutoring, social interaction and ASD

2008-02-23T16:48:00.002-05:00

A research review by Jennifer Morrison, CUNY Queens College.

Petursodittir, A. L., McComas, J., & McMaster, K. (2007). The effects of scripted peer tutoring and programming common stimuli on social interactions of a student with autism spectrum disorder. Journal of Applied Behavior analysis, 40, 353 – 357.

Purpose of the study: To explore the effects of scripted peer tutoring in reading activities, with and without programmed common play-related stimuli, on social interactions between a young student with ASD and his typically developing peers during free play situations.

Participants: A 5 yr old boy diagnosed with autism and a developmental delay. The study also included three typically developing peers from his kindergarten classroom that had no history of playing with him.

Setting: General education classroom in a kindergarten room.

Target Behaviors: The overall target behavior was to increase reading fluency by using peer influences. The reading behaviors that were included were: identifying letter sounds, decoding, reading sight words, and reading sentences.

Procedure: The boy diagnosed on the autism spectrum worked with each target peer for the reading activities for 15 minute peer tutoring sessions, four times per week, for 4 to 5 consecutive weeks. After this the participants could choose a 20 minute free play activity. The teachers that were present guided the children to play together in the same area but were also free to leave that area if they chose to do so. There were no explicit prompts or reinforcement for social interaction during any condition.

The design was a multiple baseline across peers with changing conditions, consisting of the following conditions: baseline, scripted peer tutoring, and scripted peer tutoring with common stimuli. During baseline sessions, he was given 20 min free play periods immediately following reading sessions. Scripted peer tutoring involved the same conditions as baseline, but was paired with a targeted peer. During the scripted peer tutoring with common stimuli condition, after the reading session, the play related stimuli were programmed into the reading activity itself. After the reading activity was over, the children were given other parts of the toy and encouraged to keep playing with it.

Results: The results indicated that when only peer scripted tutoring was implemented that there was no change in social interaction. However, once the peer tutoring and common stimuli condition was introduced, social interactions increased. Interestingly, when generalization probes were conducted before the common stimuli intervention, they did not see any generalization of social interaction. This could be because verbal interactions during the reading conditions were under tight stimulus control, and once common stimuli and peer tutoring were combined, generalization did occur.

Implications: This study has several important points that should be discussed. First and foremost, the importance of peer tutoring in academic situations with children diagnosed on the autism spectrum. This is something that all therapists need to keep in mind is the importance and usefulness of a typical peer model for any child with autism. A peer model not only serves as an appropriate model for academic behaviors but also appropriate behaviors in general. Instead of using adults constantly to teach children on the spectrum, we should seek out appropriate peer models that can also sit with the child and teach them various academic tasks, not to only teach them, but also to develop some type of social relationship with that given child since it is so important in building friendships, etc.

Another important point to touch on from this article is the importance of training common stimuli to promote generalization. This was first discussed in Baer, Stokes, and Risely (1968) of the importance of programming these common stimuli in the environment to promote generalization. If a child on the autism spectrum is never exposed to these common stimuli the chances of the generalization to happen in a new novel situation is slim to none. This study shows this point beautifully because there is no change in social interaction, and as soon as common stimuli are introduced the experimenter saw increases in social interaction across all three typical children. Generalization might quite possibly be one of the most important aspects in teaching children with autism academic and social skills, and if generalization is not programmed into the training program, it is much less likely to happen.

Queens College Conference: Positive Behavior Supports and Autism

2008-02-08T21:55:00.000-05:00

Queens College Center on Autism and
Related Disabilities
QC-CARD

1st ANNUAL CONFERENCE

CREATING PBS CONTEXTS AT SCHOOL AND HOME
FOR CHILDREN ON THE AUTISM SPECTRUM

MAY 3, 2008
9:30 – 1:00

KEYNOTE ADDRESS

Dr. Edward Carr
Leading Professor
Stony Brook University

“Repairing and Enhancing Quality of Life: Achievable and Hopeful”

Breakout sessions:

1. Thinking in PBS: Approaching Problem Behavior Through the Lens of PBS
Presenter: Christopher Oliva, Ph.D.
This training will focus on understanding and addressing problem behavior of children with autism in educational settings from the perspective of positive behavior support. General PBS strategies, as well as formal assessment based strategies, will be explored. Case examples will be used to demonstrate effective interventions.

2. Guidelines for a PBS Classroom: Lessons from the Field
Presenter: Angela Mouzakitis, MsEd, BCBA

The purpose of this workshop is to share classroom guidelines identified as necessary to create a "positive behavior supports" classroom. These guidelines have been identified through hands-on work, observation and consultation with classrooms that serve children with autism. Goals of the workshop are to provide guidelines for a PBS classroom, discuss and provide examples of the guidelines in action, and to provide professionals with a system for managing and monitoring guidelines, providing feedback to teacher, in order to improve classroom practice.

3. Parent Strategies for Supporting Language and Positive Behavior in Daily Family Routines
Presenter: Peishi Wang, Ph.D., BCBA
This session will explore a variety of parent-implemented interventions appropriate in natural environments with young children with ASD. Focus will be on teaching communication skills and increasing participation in family activities.

4. Friendships and Beyond: Developing Social Skills in Students with ASD
Presenter: Nicole Weidenbaum, MsEd., SAS
Success within home, school, and community settings, weighs heavily on the development of social skills. This presentation will focus on the social skills needed for students to be successful in an inclusive school setting, as well as teaching techniques that are applicable across a broad range of skill levels and settings.

5. Make It Fun and I’ll Show Up: Moving towards naturally occurring reinforcement
Presenter: Randy Horowitz, MsEd, SAS

This presentation will describe ways in which parents and teachers can establish (and maintain) themselves as reinforcing stimuli in the education of individuals diagnosed with an autism spectrum disorder. The use of antecedent based strategies to prevent problem behavior will be described in the context of designing effective behavior support plans.

6. “We’re all working really hard – but these PBS strategies are not working!”
Presenter: Sara Woolf, M.A

Does this sound too familiar? If so, come to this session to learn about team process strategies and skills that have been identified as critical in establishing successful home-school partnerships -- and developing lasting PBS outcomes. The session will focus on ways to apply “team best practices” as discussed by select school-family teams and in current literature from the fields of Special Education, Educational Leadership, and PBS/ABA.

Contact Me for Details.

The Effects of Calisthenics and Relaxation Training on Self-Stimulatory behavior: A research review

2008-02-06T19:44:00.000-05:00

A research review by Michelle Rodgers (CUNY Queens College)

Authors: Morrissey, P.A., Franzini L.R. & Karen R.L.

Title: The Salutary Effects of Light Calisthenics and relaxation training on self-stimulation in the developmentally disabled

Citation: Morrissey, P.A., Franzini, L.R. & Karen R.L. (1992). The salutary effects of light calisthenics and relaxation training on self-stimulation in the developmentally disabled. Behavioral Residential Treatment ,7, 373-389.

Purpose of this study: The purpose of this study was to determine if light calisthenics and relaxation could decrease self-stimulatory behavior. Light calisthenics was defined as 15 minutes of exercise, such as running, and bending to touch toes from various positions, such as standing and sitting.

In addition to decreasing self-stimulatory behavior, the authors also wanted to determine if light calisthenics and relaxation could also improve attention to toy tasks.
Relaxation and calisthenics were possible replacements for self-stimulatory behaviors because they were believed to provide the same type of proprioceptive feedback the inappropriate behaviors were creating.

Participants: The participants were four males ranging in age from 8-13. These males were diagnosed with the following developmental disabilities:
chromosomal abnormality with microcephaly, spastic quadriplegia with seizure disorder, chromosomal abnormality and fetal alcohol syndrome and the final subject was diagnosed with autism.

Settings: The treatment took place in a basement room located within the residential facility.

Target behaviors: The target behaviors were an increase in attending-to-tasks, through toy play, and a decrease in self-stimulatory behaviors such as hand flapping, hand mouthing, and other self-abusive behaviors such as hitting head with knuckles and body slamming.

Procedure: After a baseline of these behaviors were recorded over 5 days, treatment began. During treatment, the participants were engaged in light calisthenics as mentioned above. During the relaxation interval, they were asked to tense and relax various parts of their bodies, such as their legs, then arms, and then their hands. Free time was considered the control condition and the residents could play with various toys that were present during attention-to-task activities. The treatment sessions and control condition lasted fro 15 minutes each. After the treatment sessions, data were collected for 10 minute intervals and directly followed treatment. During this interval, the subjects were asked to play with the toys in order to measure their time on task.

Results: The light calisthenics decreased self-stimulatory behavior in all four subjects while relaxation had an effect on three of the subjects. Four subjects showed an increase in task attending after the calisthenics and only three of the boys exhibited on-task behaviors after relaxation. The only downfall to these techniques was that the effects were short-lived. The behaviors decreased immediately after the treatment sessions but had increased again later in the day.

Implications: Light calisthenics and relaxation may be good techniques to employ prior to a learning session or activity to have the most dramatic effect in increased attention and decreased self-stimulatory behaviors. The authors had mentioned that if the exercise had been directly related to each subject’s self-stimulatory behavior, the replacement exercise may have been effective and long-lasting. However, in this study, each subject, regardless of their self-stimulatory behaviors, received the same treatment. It was also noted that the effects of treatment weren’t realized until a few days after treatment. It is believed this was due to the time involved in learning some of these exercises. It was not until the subjects were more fluent with the exercises that the effects were noticed. This was speculated to be related to the amount of proprioceptive feedback that would be gained with proper exercise formation. The authors also made mention of the fact that the relaxation techniques were more laborious on the staff members because they had to help these subjects get into various positions, whereas the calisthenics were more easily implemented and feasible for a larger group.

Over-reliance on para-professionals

2008-01-26T13:19:00.000-05:00

A research review by Jennifer Morrison (CUNY Queens College)

Giangreco, M. F. & Broer, S. M. (2007). School-based screening to determine overreliance on paraprofessionals. Focus on Autism and other Developmental Disabilties, 22, 149 – 158.

Purpose of the study: The purpose of this given study was to describe a 16 item screening tool designed to assist schools in determining overreliance on paraprofessionals and from here to lead to action plan in how to fix this growing problem.

Participants: The study participants included a total of 244 screening and planning team members that were part of 27 different schools. These individuals consisted of special education teachers (n= 44), general education teachers (n=40), general education administrators (n=32), special education administrators (n=31), paraprofessionals (n=29), parents (n=23), critical friends (n=21), consumers (n=17) and others (n=7).

Setting: The setting of the study was at 27 schools in six states: California, Connecticut, Kansas, New Hampshire, Wisconsin, and Vermont. Out of these 27 schools eleven of these were primarily rural, eight as suburban, and eight as urban. 95% of the children in the study primary placement were at a general education classroom with supports.

Target Behaviors: The given target behavior was to look at overreliance on paraprofessionals in a classroom settings. This overreliance in some cases could lead to interference with the general education teacher engagement or even with peer interaction, decision making by under qualified personnel, and more importantly the development of unnecessary dependence on the paraprofessional.

Procedure: The school initially signed up for participation in field testing by submitting an application online. The schools joined the project in staggered cohorts over 3 academic years. Once the school agreed to participate, they had to submit their demographic information and were sent copies of guidelines of the research. From here each team had a 2 hour time block to meet and use the screening tool. After giving it to individuals in the school, it was then sent back and the number and percentage of schools answering each question was calculated and rank order was determined by looking at responses which included: happens too frequently, happens sometimes, or for some of the time.

Results: From the screening tool, it was determined that the biggest concerns across schools was that paraprofessionals provide academic support in subjects where they are underskilled, students spend most of their time in close proximity to para’s, students are very dependent on the para’s presence, others communicate through the para instead of the child, the child is physically separated from the rest of the class (eg back of the room) and finally that the classroom teachers are minimally or superficially involved with some students.

Other concerns included: that para’s make curricular or instructional decisions or adaptations without the classroom teachers input, the students receive their primary instruction from para’s, and when it is time to report the students progress classroom teachers rely on para’s because they know more about the student in general.

Implications: This study has several implications to special education and general education classrooms. It has become practice in the recent past to increase the number of paraprofessionals in schools in order to provide support for children with disabilities. This is ok, however, this option is one of the most restrictive supports that can be offered and should be looked at and thought about more closely without becoming the first and best option. The given school district could also look at other supports before choosing this option such as coteaching, peer supports, etc. I know that personally I have worked as a paraprofessional in the past and worked with other paraprofessionals, and these problems that are listed in the results section happen very frequently in any school setting. This screening tool could be very useful to many school districts in order to screen for overreliance problems so that an action plan can be made in order to decrease this overreliance in the future. This study brings up a lot of important concerns, being that first and foremost those children become too dependent on the para to do ANYTHING in the classroom. Another important concern is that the lack of interaction that the general or special education teacher has with the given student. This can very easily happen when the para spends 6 hrs of the day with the child and the classroom teacher does not. This is one thing that should be carefully observed in any classroom setting that the classroom teacher spends some time everyday with the student so this does not happen.

One of the most important things to keep in mind when employed as a paraprofessional is to provide support when needed but also to take a step back when the child can be independent at a given task, in order to ensure that the child will not form this overreliance on the para having to be there at all times. If this technique is used, it could be possible in the future that the child will no longer need the para in the general education setting and will just be able to use other supports in the classroom, which is the ultimate goal.

Decreasing self-stimulatory hand-mouthing behavior: Research Review

2008-01-21T22:03:00.000-05:00

Research Review by Michelle Rodgers (CUNY Queens College)

Title: Effects of providing sensory stimulation to decrease self-stimulatory behavior: using additional food to suppress hand-mouthing behavior

Citation: Yang, J.L. & Bruner, J.D. (1996). Effects of providing sensory stimulation to decrease self-stimulatory behavior:using additional food to suppress hand-mouthing behavior. Behavioral Interventions, 11, 119-130.

Purpose of this study: The goals of this study were three-fold:
First, the authors wanted to validate the functional relationship between sensory reinforcement and self-stimulatory behavior. Second, the authors wanted to determine what role sensory stimulation could play when provided as a treatment procedure. Third, the authors wanted to determine if food could serve as a sensory reinforcer to replace hand-mouthing behavior.

Participants: The participant in this study was a 30.5 year old nonverbal male with profound mental retardation.

Settings: The setting was the large dining room within the state care facility in which the participant resided. The participant typically sat with three of his classmates.Target behaviors: Hand mouthing was defined as momentary insertion of any finger covering the first knuckle between the lips.

Procedure: Data were collected twice a day during baseline and treatment conditions. The data were collected during a structured morning activity and during a less structured activity in the afternoon. During the baseline phase, the participant received his usual meals, with no additional food given. Any hand-mouthing that was observed and recorded were never stopped or interrupted. During the intervention phase, the participant was given his usual meals. However, he was also given additional portions of bread, fruit and milk. He was able to eat as much or as little as he wanted. Data was collected for three months after treatment was employed.

Results: The participant’s hand-mouthing behavior decreased from 67% in morning activities to 13% after treatment, His hand-mouthing behavior in the afternoon decreased from 47% to 17%. During the follow-up, the participant averaged 12.5% hand-mouthing behavior in the morning and 10.4% in the afternoon. The participants weight was also observed. The participant gained 19.5 pounds during this study and was within his ideal body weight. In addition to the behavior decrease, the participant’s hands healed and he was able to sleep longer throughout the night. He no longer needed insomnia medication or restraints to prevent tissue damage to his hands.

Implications: In this particular case, the functional analysis of the hand-mouthing behavior allowed the authors to conclude that food would be a viable replacement. This study is somewhat limited in its generality to other individuals engaging in hand-mouthing behavior because there was only one participant. Although increased food intake worked for this individual it may not work for others.

However, with that being said, increased food decreased the hand mouthing and was less labor intensive for the staff at the facility. Permitting extra food at meal times was an easy solution to the hand-mouthing behavior and was not aversive to the participant nor did it pose an ethical dilemma for the staff as the restraints had. On the other hand, with increased food comes weight gain. This particular individual happened to need to gain weight but other participants may end up with a health problem. It is therefore suggested that individuals undergoing this increase in meals to prevent hand-mouthing, get additional exercise and perhaps some foods that provide chewing sensations without significant calories, for example chewing gum.

Relationship of Self-stimulation to learning in Autistic Children

2007-12-12T11:35:00.000-05:00

A research summary by Jennifer Morrison - CUNY Queens College

Koegel, R. L. & Covert, A. (1972). The relationship of self-stimulation to learning in autistic children. Journal of Applied Behavior Analysis, 5, 381 – 387.

Purpose of the study: To complete a functional analysis of the relationship of self-stimulatory behavior to learning in children diagnosed with autism.

Participants: The study included three children diagnosed with autism. These three children engaged in a variety of self-stimulatory behaviors such as body rocking, hand play, gazing at lights and repetitive vocalizations that interrupted their learning experiences.

Settings: The setting of the two experiments was at the three children’s home.

Target behaviors: Rhythmic body rocking, waving of hands: or objects in front of the eyes, gazing: which included looking at the house light, hand gripping: between fingers on both hands, hair twirling, hand/arm flapping, and repetitive vocalizations.

Procedure: In order to treat the occurrence of self-stimulatory behavior, the experimenters used a suppression technique which in experiment one included saying “no” and using a physical prompt to stop the self-stimulatory behavior in experiment one.

In the second experiment, they did not use the suppression technique and instead used a discrimination training exercise with the children. So for example, they would do a typical discrete trial type of format and present the child with the colors yellow and green and teach the child how to choose between the two colors. The experimenters hoped that by doing this it would decrease the amount of self-stimulatory behavior.

Results: The results of this study show several interesting things. In experiment number one, they showed that the suppression technique decreased the amount of self-stimulatory behavior but there was no evidence to show an increase in the number of correct trials of discrimination.
In experiment two, however, it showed that for one participant that the amount of self-stimulatory behavior was decreased and also the percent of correct trials increased also.

Implications: This study has quite a few major implications. First of all, from the results of experiment two, this show that perhaps indeed a positive reinforcement procedure is more effective than a punishment procedure in decreasing the amount of self-stimulatory behavior. The nice thing about the discrimination training method is that it also increased the percent trials correct by this particular student. This is an important implication in the treatment of self-stimulatory behavior in children with autism. The use of punishment should be a last resort and only used when all other possible reinforcement strategies have been tried. It is also important to look at the relationship between the self-stimulatory behavior and learning. It has been shown in this study that when a child is engaging in self-stimulatory behavior that they have a hard time attending to other things in the environment. This is an important idea to keep in mind in school and home based programs, especially before teaching a given topic. It is very important that if a child that is engaging in self-stimulatory behavior they are engaging in appropriate attending behaviors before beginning a new learning trial, and also that they are attending to the correct stimuli in the environment in general. If these two things are not present, then the chances that learning will happen are less likely in some situations.

Research Summary by Michelle Rodgers

2007-12-11T13:54:00.000-05:00

I am mentoring several professionals for their BCBA accreditation. In this process, they are required to read and review evidence-based practice in the literature. We thought it would be helpful to disseminate these reviews with parents and professionals. These are overviews of specific articles, not comprehensive literature reviews. I will post them up periodically. Enjoy.

Authors: Koegel, L.K., Koegel, R.L., Hurley, C., and Frea, W.D.

Title: Improving social skills and disruptive behavior in children with autism through self-management

Purpose of this study: To determine if self-management could be helpful in increasing social interactions and responses for children with autism, within the community, home, and school settings.

Participants: Four children with autism. These children had been identified, by caregivers, as unresponsive to other’s social initiations, even though they had at least the social skills of a three-year old. These children were also reported to engage in disruptive behaviors as a result of interactions initiated by others.

Settings: As a result, a clinic and community setting was used for each, while a home and setting and a home and school setting were used for two others.

Target behaviors: Making an appropriate response to social interactions of others through a verbal response within 3 seconds. An inappropriate response was defined as no response within 3 seconds, a response unrelated to question, or an echolalic response.

Procedure: A small wrist counter and edibles were used for the procedure. In order to teach the children how to self-manage, a clinician modeled an appropriate response to a question for each child. Then the clinician modeled how to make the indication through the wrist counter. Inappropriate interactions were also modeled and the clinician showed the child that a point could not be counted on the wrist counter. Once the child was wearing the wrist counter the clinician continued to model the procedure until prompts were faded. The children were reinforced for appropriate recording and this schedule of reinforcement was gradually thinned.
The children were also taught to reinforce themselves after a certain number of responses were recorded on the counter. The prompts for this procedure were also gradually faded. After these steps were mastered by the children, they were able to use this method of self-management in the other settings.

Results: The children had high percentages for recording appropriate responses and not recording inappropriate behavior. In addition to learning the self-management procedure relatively quickly, the children’s level of social interactions towards others increased in all settings. Disruptive behaviors were also lower after self-management was employed.

Implications: Self-management can be a successful technique to increase appropriate social interactions and decrease disruptive behavior in children with autism, who are functioning at or above the typical benchmarks for three-year-olds. This is a valid technique to decrease the amount of adult support that would otherwise be needed. Obviously, increased social skills allows for more social a

Response to Intervention (RTI) and Applied Behavior Analysis (ABA)

2007-11-13T23:47:00.000-05:00

Response to intervention has been getting a lot of air time lately both in school psychology and special education circles. A explanation of RTI and how it relates to ABA I thought was in order.

Response to intervention is essentially a model of intervention and diagnosis. The current model for referring and diagnosing students with disabilities is to refer them for an evaluation, which can take months for the referral, another month for the eval, another month for the report, and may lead to a referral that will not work for the child (e.g. resource room). RTI aims to change this process.

Defined: “…RTI is an objective examination of the cause-effect relationship(s) between academic or behavioral intervention and the student’s response to the intervention”

Basically, to identify if a child is having difficulty learning, the way you identify the disability is by monitoring their progress and looking at how they respond to a particular intervention.

Core Elements:
- Intervention is organized into levels of intensity
- It is diagnostic…if a child doesn’t respond to an intervention, could be indicative of a disability
- Keeps teachers and schools accountable
- Ongoing data collection
- Pre-referral

Basically, you need to monitor a child's response to a program through data collection and use their response to give you information about how to proceed.

Three Tiered Interventions:
First Tier: What you do at the first sign that a kid is struggling…basic classroom modifications.
Need to answer the question:
- Are routine classroom instructional modifications sufficient to help the student achieve academic success?

Second Tier: Individualized interventions tailored to the struggling learner
- For students that have failed with Tier 1.
- Can the individualized intervention plan carried out in a gen-ed setting bring the student up to the academic level of his or her peers?

Third Tier: The most intensive academic supports available in the school
- Generally for students with chronic and severe academic delays or behavior problems
- Often only available through special education
- What ongoing supports does this student require and in what settings should they be provided to facilitate the greatest success possible?

As a teacher:
- Need to monitor struggling students
- Act quickly, and support them early on
- Collect data and monitor progress
- Have access to a pool of resources of evidence-based strategies
- Monitor and track what you have tried, how effective it was or wasn’t, and communicate this to your school-based support team.

RTI is essentially a system to begin intervening and monitoring progress immediately in a classroom. How is this different than what is done in ABA programs? Behavior analysts identify a need, or a struggle, and implement an intervention, monitor progress, and change the intervention as needed based on the data. RTI is bringing this to the regular education classroom: guidelines to use these methods to work with struggling learners in regular education settings.

It is great to see data-based decision making entering our schools and the mainstream. However, it was written into the law in 2004 and is still not universally accepted in most schools, but it is a start.

I would love to hear any experiences with the RTI model in schools.

NYSABA Conference: November 1st and 2nd

2007-10-28T11:39:00.000-05:00

On November first and second, the New York State Association of Applied Behavior Analysis (NYSABA) will be hosting a conference at Turning Stone Casino in upstate New York. It promises to be an exciting and informative conference with well known speakers including John Baily, Dennis Reid, Peter Gehrhardt, and many others for invited addresses and small group workshops. See the link below for additional information on the conference schedule.

http://nysaba.org/mn_downloads/2007NEWconference_schedule.pdf

I will be presenting two workshops:

1. An Introduction to Applied Behavior Analysis for Parents and Professionals.

2. Pre-K Inclusion for Children with Autism: How to merge ABA and "Just playing and learning with other kids"

It is a two day conference and offers an array of speakers. Hope to see you there!

Conference in NYC: Meeting the Needs of Young Children with ASD and Their Families in Everyday Life: Sensory and Behavioral Perspectives

2007-10-08T12:35:00.001-05:00

I wanted to share this presentation with readers. The purpose of this presentation is to address concerns that parents and professionals have working with their children in the community. This presentation is a little different than others in that it addresses community situations (e.g. restaurants, doctors visits, birthday parties) from both a behavioral and sensory perspective. The information is below and seats are limited.

CENTER FOR AUTISM AND RELATED DISABILTIES (CARD) at Hunter College

in collaboration with
Resources for Children with Special Needs, Inc.
and the
Early Childhood Direction Center/Manhattan
New York- Presbyterian Hospital
Presents a seminar for families and professionals

Meeting the Needs of Young Children
with Autism Spectrum Disorders
and Their Families in Everyday Life:Sensory and Behavioral Perspectives

Saturday, December 1, 2007 9:00 AM- 1:00 PMRoom 714 West, Hunter College (SW corner of E. 68th Street and Lexington Avenue)

Moderator: Professor Shirley Cohen, Director, CARD at Hunter College and author of the book Targeting Autism.

Presenters:
Lindsey Biel, M.A., OTR/L, pediatric occupational therapist and co-author of the book Raising A Sensory Smart Child

Jamie Bleiweiss, M.A., behavior specialist, consultant for the ASD Nest program, and advanced doctoral student at Stony Brook University

Angela Mouzakitis, M.S. Ed., BCBA, faculty member, Graduate Programs in Special Education at Queens College, consultant for the Intensive Kindergarten, and advanced doctoral student at The Graduate Center of CUNY

Admission is free. To reserve a place, register in advance by leaving an
e-mail message with your name and phone number at: hcard@hunter.cuny.edu or (if you do not have access to e-mail) by calling (212) 772-4822 before Tuesday, November 27, 2007.

Coffee and sign-in at 9:00. Presentation begins promptly at 9:30.
(Childcare will not be available at this conference.)

Classroom Management in Special Education, Pre-K and K: Notes from consultation observation

2007-10-03T09:42:00.000-05:00

(Before I start, my spell check isn't working so pardon the errors.)

In some of my consultation work, I see classrooms that are just getting started with children with autism. While they may not incorporate DTT in their instruction, the principles of behavior analysis are applied and are inherent in proper classroom management. I wanted to post some of the recommendations I have made across classrooms: these are simple changes that can be made to help the classroom run more smoothly, aid student transitions, and help students understand the expectations of the classroom and day. As the school year goes on, I'm sure more suggestions will come up.

Before I post the observations and recommendations, I want to be clear that working in a classroom with children with varying needs and disabilities while rewarding, is incredibly challenging. I have taught in these classrooms, and recognize that as a consultant, it is easier to identify ways to improve the classroom that may be difficult to see when you are in the trenches, on the floor, with a child that is frustrated and showing you how frustrated he is (to put it mildly). I give props to these teachers and the efforts they make to teach their students and work diligently to ensure that they progress over the weeks, months, and school year.

1. Follow the lead of the classroom teacher - Teacher assistants are not shadows for our children. They are essential members of the team, without which, these classrooms wouldn't work. But there is also a role that needs to be followed. Teacher assistants need to support the teachers lead, follow it, and ensure that the students are attending to the teacher. There should be no side converstations, or additional and possibly contradictory directions given. For example, if a teacher assistant says "time to clean up the blocks now" and then the teacher makes an announcement "Clean up in two minutes" the student(s) have just been given a contradictory message. Keep it consistent, and keep the big direction coming from one person.

2. Any activity can be turned into an instructional acitivty - Even clean-up. In many classrooms, adults are doing the clean up while the children are running around with the classroom teacher trying to get them to sit. Every part of the day can incorporate instruction and language. clean up can have a visual schedule that children need to follow and complete. Within this visual schedule, you are working on picture recognition, reading, following a sequence, communication, attention, and appropriate clean up skills. This will not only teach, but keep the children engaged during transition activities which decreases probability they will get more riled up while clean up is completed by someone else.

3. Length of time in group instruction - For many of out children, staying in a group is not a time for instruction, but rather a big "wait" program. Waiting is an important skill to learn, but should not be run this frequently. Group instruction in these class is often too long, and after 5-7 minutes, instruction is lost, children get antsy and problem behavior develops. Proactively, limit group instruction and after 5-7 minutes provide an interactive hands on activity that will apply the group instruction. This goes for circle, morning meeting, math lessons, writing, etc. Change it up before things get ugly.
Example: Break a lesson up with different activities that might address the same concept
Math – a math song, manipulatives at table, math and the computer, counting with blocks,
number hunt in the classroom (each less than five minutes)

4. Don’t push the children too far beyond what they are capable of – We want the children to continue to learn throughout the day, but it is everyone’s responsibility to ensure that we are pushing the children to their appropriate level and not to do something that is way beyond their ability level.
For example: A child that is using one-word requests, can be pushed to use a two-word
request, but if you take it further than that, frustration is inevitable.

5. Individual schedules – As the first couple of months of school are passing, attend to who would benefit from and individual schedule, prioritize and slowly introduce it with each child. See Krantz and McClannahan for information on creating visual schedules.

6. Respond to appropriate requests – Most of our kids have a difficult time with communication skills and behavior. Therefore, we want to ensure that when the DO use appropriate language, that we are responding to them quickly and appropriately.
Even if a request cannot be honored, acknowledge it and identify when it can be honored, or a replacement suggestion. Otherwise we will be encouraging perseverative requests.

7. Modify lesson on the spot – If you are engaging the students in a lesson, and it looks like it is not working, change it or modify it based on your student responses
Example: Observing that a game is becoming "tired" and children are losing interest,
change it and move on, or you might incur the wrath of problem behavior. Proactively,
identify what your students can handle.
Example: If children aren’t responding on the rug, get them off the rug and change it up.
You might address the same skill at the table, then move them back to the rug to break it
up, and then even to a different spot in the room to generalize the same skill.

8. Table top time – This is not a time for just independent play. We need to engage the children with: Language, Play models, New play ideas, Commenting
Example: Maybe create idea cards to keep in each activity bin to help each child come up
with new ideas on how to play with the activity.

9. OBJECTIVES – For each lesson plan, activity, song, manipulative, we need to have a “POINT” to the lesson. Look at your activities, and write out objectives of what you think and what you want you students to get out of the activity. Start simple, with one or two objectives for each activity, and maybe alternate them between days.
- Move on when the students have mastered the objectives
- Differentiate objectives depending on the students level
Having written objectives is the ONLY way to know if our students got something out of your lesson. It makes your lesson measurable.

10. Positive feedback – Children need to get not only corrective feedback about their behavior, but positive feedback about what they are doing correctly. This needs to be differentiated for each child and by each activity
For example, if we know a particular child has a hard time with writing, we need to
increase praise feedback during writing, while other times that he has an easier time, we
could decrease the positive feedback making it a little more natural and sporadic

If we see a child is not responding, it may not be a skill deficit, but no understanding the expectation and needed clearer reinforcement. Bump it up a notch to get them excited again.

11. Pre-requisite skills – When preparing a lesson, keep in mind the skills that are needed to perform the activity that might be unrelated to the goal of the program: You may need to teach them first before you implement your lesson:
- Waiting in line to jump in a bean bag and find a match
- Sitting on the rug appropriately in order to engage in a math lesson on the rug
- Holding a crayon properly in order to color and identify a rectangle

12. Identify when the activity should end – Sometimes an activity can be modified and maintain the children’s attention, other times it needs to end. We need to REALLY attend to the behavior of our students in order to identify when it is time to end the activity and move on to something else.

13. Pay attention to your staff ratios when lesson planning – Staffing is often a problem, and some lessons don’t work, no matter what, with only two staff in the room. Monitor and plan accordingly. Additionally, when you have high staff ratios, plan your intensive 1:1 academic time. These are opportunities to be capitalized on with no one on book on tape, long-term computer, or independent activities.

Hope some of these guidelines help. As always, feedback is requested and welcome!!

Prioritizing Behavior Goals

2007-09-18T08:12:00.000-05:00

The first month of school is now in full swing for most of us. I've been working in several schools as a behavior consultant, and while problem behaviors abound, none are particularly unique. What is especially abundant across all classrooms I have worked with is the urgent need to fix everything immediately so that the class can run smoothly. This is not possible and it cannot be understated that this "need" to get the class under control immediately will hinder actual progress.

Priorities need to be made. While all children in a class need to make progress and we want to help them all equally, there are several challenges that we face working in classrooms, and we need to prioritize what is feasible to target. Where do you begin?

First, I would recommend, do not go in with your arms swinging getting ready to change everything immediately. The first few weeks of school are challenging, and many of the challenges subside as children acclimate to their classrooms. The child that is engaging in tantrum behavior because Mommy is leaving, will most likely decrease this behavior as he learns that reinforcement is accessible at school as well. It is easy to feel overwhelmed at the beginning of the school year and that things will never calm down, but wait a few weeks, provide your class with the structure and consistency that you promised, and some of the challenges will subside.

Second, take data. These first couple of weeks will give you invaluable information about where your students have started for you to compare and measure progress come December, March, and finally June. Data doesn't always mean numbers and figures. At the end of the school day, a sentence or two on something eventful for each child in your class will give you an anecdotal record of the child's current level of functioning for you to compare. For example:

- Jonathan 9/13/07 - No verbal behavior today. He watched peers playing for two minutes but kept to himself and engaged in self-stimulatory behavior most of the day.
- Jonathan 10/14/07 - Initiated play with a peer by handing him a block. Said "help build"
- Jonathan 11/5/07 - Used subject object verb to ask for help "alison, open box"

A sentence for each student might give you more information than you thought, and is a nice anecdotal gauge of progress. It shouldn't be the only measure of progress, but in the beginning, when you aren't sure what to target and what areas of concern will be, this anecdotal record may help you to pinpoint some areas of concern or areas of a child's strength.

Third, after a week or two has passed, and you have taken some anecdotal notes, take a look at what some of the significant challenges may be. If you have a child that is tantrumming at high rates in your class, this is a priority. The disruption will hinder learning for other students, disrupt the flow of the class, and affect the atmosphere you may be trying to develop in your classroom. It is when this priority has been identified, that formal functional behavior assessment should begin, and a formal plan should be implemented soon. If five children are engaging in significant interfering behavior, pick ONE to start. You will be more effective putting your energy into one complete assessment at a time, rather than attempting to cover all the students in your class and not being comprehensive across any of the plans.

This is important, as it is more the norm that everything is tackled at once, with less precision and skill. A classroom may have many students engaging in problem behavior and all interferring behaviors are tackled at once in a half-assed manner, more out of desperation than out of carelessness. Take the time now, to work through each child comprehensively, and the benefits will be reaped later on.

Fourth, Communicate with the related service providers and your team on a regular basis. If you are working with a population that requires extra support, weekly meetings should already be in place. If not, make an attempt to touch base with the team members weekly. Priorities should be identified and discussed across a team, and all team members should be consistent.

Fifth, take data. As you identify your priorities, you should be taking data on the levels of interfering behavior before you intervene (baseline) and the levels of interfering behavior after you intervene. For example:

- September summary (baseline) - Jonathan averaged 45 instances of screaming per day
- October summary (intervention - behavior plan implemented) - Jonathan averaged 25 instances of screaming per day.
- November summary (intervention - same) - Jonathan averaged 10 instances of screaming per day.

This simple frequency data gives us information that our plan may be working.

To be clear, I'm not advocating that the rest of the children in the classroom be ignored while Jonathon is our focus, however, as data collection and functional behavior assessment starts for Jonathon, you can move on to identifying the next priority and preliminary data collection can begin on Kaitlin. I am admonishing, however, that to attempt to fix everything in the first month of school will not end in success.

Does it really matter what orienation a strategy comes from???

2007-08-23T15:17:00.000-05:00

I'm getting tired of defending the principles of behavior at different meetings and to colleagues. Frankly, I shouldn't have to defend them. Whether you like it or not, the principles of behavior are exactly that: principles. They aren't theories, they aren't underlying orientations. They are principles of behavior that explain learning. Period. It is not a religion. You can't choose to BELIEVE in behavior analysis. Behavior analysis doesn't ask you to believe in it. The principles are as concrete as the grass is green. The principles aren't debatable. They exist. That being said...

Any teaching strategy that includes these principles and uses them to teach a child is fair game. As long as you can measure it, gauge progress, use it. Did you know that Greenspan was the first guy to say "put it high up on a shelf so the child can't reach it, and that way he will be encouraged to ask for it..." Does any behavior therapist or analyst NOT do this??? Because Greenspan did it, and I disagree with other methods of his, does this preclude me from using this strategy because I am an ABA therapist? Of course not, and it is just as ridiculous to exclude effective strategies that may stem from other disciplines, as it is for the interventionists from these programs to pretend that their strategies are not behavioral in nature.

To be honest, I don't consider this an eclectic model either. I consider it a behavioral model. This is because I am monitoring effectiveness, using the principles of behavior, and teaching and shaping a behavior. The idea may have come from Greenspan, but this does not make me a Greenspan follower. I think it is a cool and good idea, and I will try it in my programs. This is the beauty of behavior analysis. You are not limited. Your role is to identify a goal, find a way to measure the behavior, find a way to teach it, apply the principles, and analyze your effectiveness. Not to shy away from a program that didn't first appear in The ME Book.

Eye Contact: ABA, DTT, and RDI

2007-08-14T08:39:00.000-05:00

Eye contact for children with autism is always a concern. Well, not always, but usually. I do work with one little boy that appears to love looking people in the eyes and teaching this skill took all of four days when he was two-years old. For the rest of our kids, it can be very challenging.

Different orientations go about teaching eye contact in various ways. While I've voiced my opinion on RDI in the past, I will discuss it as additional strategies here. But in summary of previous posts, behavior is behavior. If you want to teach a new behavior, like eye contact, it WILL be taught using behavioral principles, whether you are comfortable calling it that or not. RDI provides us with strategies that modify the environment and provide creative ways to elicit eye contact, but eventually that eye contact is reinforced (ABA) shaped (ABA) given differentiated reinforcement depending on quality of eye contact (ABA) elicited by modifying the environment (ABA) elicited by using a discriminative stimulus (ABA). It is all ABA.

Where ABA has fallen short on the eye contact issue, in my humble opinion, is by not exploring more creative methods to elicit eye contact, and to make giving eye contact important. I'll go over some traditional methods that have been used to elicit eye contact, and then how some RDI ideas can be incorporated into an ABA program (since they are all based on behavior principles anyway.)

DTT - Discrete Trial Instruction/Training programs tend to teach eye contact in very contrived situations. A child will sit opposite a therapist, and given the directive "look at me" or the child's name will be called. Depending on the level of the child, a reinforcer will be held at the teacher's eye to help the child understand where they should look. Contingent upon eye contact, the child will immediately receive the reinforcer, possibly providing a token, and providing praise. It make look like this.
Teacher: "Look at me" (while holding an M&M at her eye)
Child: Looks at M&M and glances at teachers eye
Teacher: "Excellent looking" and provides M&M immediately.

This is an effective method and will teach a child to look at someone at the eyes when a demand is placed, when their name is called, when a reinforcer is present. However it doesn't always generalize. Some children that I work with look at me beautifully in the eyes, but when their grandmother says hello, they are looking anywhere but her eyes. Why? Maybe because she is not holding an M&M or a reinforcer in her hand, so the MO (motivating operation) to look in her eyes is not there. The child has not generalized that looking at people in the eyes is reinforcing.

ABA - Applied behavior analysis will of course incorporate the strategies used above, slowly fading out the item at the eye, just like DTT, until the child looks at the teacher's/parent's eyes without have a reinforcer within eye sight. Other methods are always used. In my programs, I prefer not to demand eye contact, but rather to wait for the child to initiation eye contact and reinforce the spontaneous eye contact. An example of this is the following

Teacher: Holding Elmo toy that two-year-old child with autism clearly wants to play with.
Student: Pulling at the toy, while staring at the toy
Teacher: Teacher looking at child's face, not letting go of the toy
Student: Still pulling at toy
Teacher: Still holding toy....continues to hold on until child glances up at which point the toy is immediately provided with praise and excitement.

This method reinforces spontaneous eye contact as opposed to eye contact that is requested. What ABA therapists do is contrive the environment to elicit eye contact, and reinforcer the eye contact, assuring that future eye contact will occur at higher rates due to the reinforcement.

RDI? I don't think RDI strategies are inconsistent with applied behavior analysis (ABA). What I have learned by attending these seminars is how to be more creative with my children. How to give my a children cool reasons to look at me, give me eye contact and enjoy themselves while doing it. It is these cool creative ideas (reinforcing events) that when used in the environment (modifying the environment) will provide a stimulus (SD) to elicit eye contact (response). (Do you see how it all falls so nicely into behavior principles.

I tried some of these strategies with a child that I work with. RDI talks about doing the unexpected, getting creative, and making kids care about giving eye contact. Now, I don't know if I am making them care about giving eye contact as it isn't something that I can observe, but what I CAN do is note the response, which was fantastic, and it didn't include reinforcing objects, rather reinforcing people (myself). That is one of the core tenets of RDI: to keep objects out of it and build relationships with people, which is quite different from ABA and DTT which rely on tangible reinforcers heavily.

I sat opposite a five-year old child with autism, removed toys and reinforcers out of sight in the environment, I positioned myself in front of him and waited. He didn't look at me, save the occasional glance. When he would glance, I smiled. See below

Child: Glanced
Teacher: Smiled
Child: Glanced again
Teacher: Blew air in his face
Child: Giggled
Teacher: Waited for eye contact again
Child: Gave it much more quickly
Teacher: Pinged child's nose
Child: Giggled, and while maintaining eye contact, blew air in teachers face
Teacher: Giggled, and made a raspberry on his cheek
Child: Giggled, and laughed, and said "blow"
Teacher: Blew air in his face, then by his ear, then on his toes
Child: Giggled, and pinged teacher's nose.

This went on, while maintaining eye contact. This is not an RDI program, this is an ABA therapist, using some of the creativity from RDI, and reinforcing and shaping the eye contact behavior of the child. At the end of this interlude, before he got tired of the game (satiated) I laid down on my back and left him alone. Normally, he would have walked away and found a toy to stim with. This time, that didn't happen. He watched me lay down, walked over to my face, looked at my eyes, giggled, and blew air at my cheek. I had made my eye contact and interaction reinforcing to him, so much, that he was seeking it out.

Understanding the Speech Mechanism: Impact on teaching and program development.

2007-08-01T12:52:00.000-05:00

I was co-treating with a speech therapist on Monday working with a child with autism that also appears to present with severe apraxia. While I'm not ready to debate the diagnosis or what it means, what is clear is that the child has a very difficult time articulating. Now as an ABA therapist, what does this mean to me, and how can I teach or shape his vocal behavior?

Many ABA therapists and programs do not feel that certain related services are necessary and that all behaviors can be addressed in an ABA program. While I agree that using good teaching and analyzing behavior and shaping behavior this is true, I as an ABA therapist simply do NOT have the knowledge base that a speech therapist has and I feel that this role is imperative on a team. That being said...

The two of us were targeting the "eh" sound found in many words, and the therapist was talking to me about "jaw grading". I didn't know what this was, nor had I ever tried to monitor it or shape it. Getting into a discussion about articulation, we discussed all the components within communication and cognitively, that a child must be able to plan (motor planning) or rather coordinate in order to speak and more importantly, to articulate so that he can be understood. Below I will highlight the areas as I understand them, as a behavior analyst, not as a speech therapist.

Jaw grading - the child needs to open his jaw to an appropriate degree, and this requires planning. For example, a jaw almost completely closed (found in the 'eee" sound) or completely open (found in the 'ah' sound) are the easiest positions and easier to shape and teach. However, three positions in the middle (one of those producing the 'eh') are levels of jaw grading and requires skill to identify what level the jaw should be open to target a specific sound
Lip closure - in addition to the above, lips need to be shaped in a certain way in order to produce target sounds, paired with appropriate jaw grading. Another area that a child must gauge level of lip closure, opening, forming, etc. that is needed in order to produce the target sound.
Tongue placement - while all this is going on, the child needs to place his tongue in the correct position, which is also difficult to prompt. Therapists have become quite adept at prompting the lips and jaw, but the tongue presents quite a challenge, as evidenced in trying to teach a child with artic difficulties the "l" sound.
Breath and volume - how loud the child says the target. With kids that are low-tone, this presents as a unique challenge.
Tone - how appropriately is it said? This can be a problem for many children on the spectrum who sound robotic at times, or their voice fluctuation is off.
Retrieval - Cognitively, in addition to all of the above, the child needs to retrieve the target label, request, word, etc. when needed. Often children will imitate beautifully when presented a model, but the word falls apart when they have to label it with no model, or are requesting spontaneously.

All of this, requires a lot of work for some of our kids. It is amazing they find the energy to talk at all, given how much is involved and how much cognitive energy must be expended in order to get the target out.

What does this mean for our programs?

- Collaboration with speech therapists is necessary, and how to prompt the appropriate Jaw grading, lip closure, etc. is imperative. While as ABA therapists we are not PROMPT trained, there are techniques that can be taught to us to help us obtain the target sounds.

- Practice. Repeated practice in isolation and distributed practice throughout the day (sound familiar?) However the targets need to be clear and identified upon in a team fashion with the speech therapist input regarding the skills mentioned above and what the child is capable of doing at this point.

- What is difficult? When functional words you want to target encompass skill levels that the child is having a difficult time with. This is where speech and ABA butt heads a little. The speech therapists want to hold off on the words and sounds the child can't say until they can do so with fluency, and the ABA therapists want to get this kid communicating one way or another. A compromise has to be reached here. Functional words need to be targeted, while these sounds may need to be prioritized as speech goals. For example "I jump on trampoline" may be impossible for a child to say, but it is his favorite activity, and asks for it a hundred times a day, the articulation needs to be shaped, even if it appears he isn't ready for it.

Co-treating with speech therapists is always incredibly informative, this time more than others, and I felt like I had a stronger understanding of "why" a child may not be able to get a word or sound out. This also shows how collaboration is necessary in addition to informative and helpful. Any comments are appreciated. I do have a lot more respect for how touch it is for some of our kids to get these words out and give them props for trying.

Observation of a DTT Classroom: One example

2007-07-24T16:48:00.000-05:00

I had the opportunity to observe a classroom that followed a strict DTT model. The students in the class followed schedules, and were on half hour schedules of DTT work with instructors. The students were all on token schedules individualized to their own level of tolerance. For example, some students were on token boards that consisted of ten tokens, others of five tokens.

Each work session consisted of a particular program targeted. For example, a child would be presented with a picture I.D. program. He was presented with the materials and provided tokens for correct responding. Occasionally mastered social questions were intermixed.

When the child earned his reinforcer (after having earned all of his tokens) the instructor provided him with the reinforcer to enjoy on his own.

What struck me about this program was the lack of interaction between the teacher and students, let alone between the students with other students. All of the interactions between teacher and student were in the form of directions and praise. There was no act of developing a relationship, playing, or playful interaction. There was also little or no requesting on the part of the student.

While DTT is an effective strategy, I was taken aback by the lack of friendly, playing and relationship building time during this observation. My post was spurred by my urge to caution programs against this. I can't understand why DTT in this setting couldn't be implemented in addition to strategies that address rapport building and spontaneous language in the form of comments and requests. The students in turn responded by providing little eye contact or interaction with the teachers.

DTT will teach skills, but these skills are useless if they are not practiced in a functional manner throughout the day. Reinforcement from people should be built into these programs. If a child earns a toy as a reinforcer, a teacher or peer should be involved to help these kids find reinforcement from people, not just from things. Rather than standing back during periods of reinforcement, teachers and peers should be paired with reinforcers, breaks, etc.

In some models that incorporate a strict DTT strategy, spontaneous language is punished rather than reinforced. For example, if a child looks out a window and appears distracted, this is a learning and language opportunity. It may not be appropriate to automatically redirect the child to the task at hand; rather capitalize on this opportunity to prompt language "I want window" talk about the window, and then even incorporate it into reinforcement. Reinforcer assessment should be ongoing and dynamic. Reinforcers changed and constant analysis of this change is necessary.

Another observation was the immediacy of prompting if a child didn't respond. For example, if a child wanted to access a reinforcer, and did not provide the appropriate request within a matter of three seconds, the language was prompted. If the language is within the child's repertoire, I personally would have waited a bit, to see what the child would give me. Something motivating is already present. Waiting, might have gotten a more independent response and reinforced the independent request, rather than possibly encouraging prompt dependency. I'm not recommending waiting for minutes, rather just wait a bit longer for the independent mand/request.

While models differ, DTT, RDI, PBS, VB, ABA, I can't understand why there needs to be such a clear distinction between these programs. Some skills are effective taught in DTT, but there shouldn't be a reason to neglect strategies that develop relationship between our kids and people, nor should spontaneous language and manding be ignored. I don't see this as an eclectic model. I see this as ABA. The principles of behavior should be applied to any strategy, but across domains. The model I observed mentioned above, to me, seemed to be lacking. I'm not debating the effectiveness of DTT. I not only acknowledge it, I revel in it, and incorporate it when needed in my programs. But it isn't the only strategy, and I'm curious how social and relationship development domains are expected to progress when they aren't addressed in a functional manner with distributed practice over time and context.

The challenge becomes how to incorporate these evidence based practices into a program that addresses the whole child: social, behavior, academic, communication. These areas can be address in programs that follow the principles of behavior analysis and are monitored for effectiveness with changes made as necessary. They cannot all be addressed using one strategy and one strategy only.

To iterate, re-iterate, and re-re-iterate, DTT does not equate ABA. A program that follows DTT is doing just that, follows a DTT model, and doesn't necessarily follow all the principles that an ABA program would entail.

Teachers and Therapists: Reinforce the good ones

2007-07-19T09:28:00.000-05:00

I noticed after perusing my blog topics, that I talk a lot about parent collaboration, the need to include parents, and the tendency for some professionals to discount parent input. But there are so many dedicated teachers and therapists that go above and beyond for their families and children and they need some acknowledgment and discussion.

Working with children with autism is rewarding, but is also very challenging. In the programs where I teach, I am constantly reminded not only of the challenges that school and center-based classroom teachers face, but also the dedication that many of them exhibit to obtain information, resources, and support to work with these wonderful yet challenging kids. Some of the schools that they work in are incredibly under-supported and underfunded, and often, teachers will dig into their own pocket to purchase materials, snacks, and activities for their classrooms. This is not the case of all teachers, and we have all encountered the jaded and miserable teacher who is counting down the days till summer and breaks, but lets not forget about the dedicated teacher that is busting his/her hump to work with and teach children using evidence-based practice. It is a really difficult thing to be a good teacher, and they should be praised for it.

The home-based teacher/therapist has other challenges. It is difficult to find good home-based therapist because the job doesn't always reap the same benefits as a center-based program. At a center, all the kids are there, you drive to one place, have built-in paid prep times and breaks, and have a host of colleagues that you can trouble-shoot with, complain to, and chill out with in the faculty lounge. You have a guaranteed salary and supervision as needed. Health care is provided and summer breaks are also guaranteed, with the option to work should you so choose. Maternity leaves are included, and sick-days are provided without complaint.

The life of the home-based provider is very different, and not always coveted. While the pay (at least in New York State) is not-bad, there are many sacrifices that are made: living out of your car, paying for all your supplies and resources out of pocket, going into some one's home on a daily basis (essentially have no home-base of your own), limited interaction with other team members save monthly team meetings (if you are fortunate enough to be on a team that has monthly meetings), gas prices, last-minute cancellations, dead time between sessions, guilt over bathroom breaks, and guilt over therapists having to cancel and feeling the need to explain why. Additionally, the lines of responsibility of the home-therapist may blur at a much faster and more significant rate. Going into someones home on a daily basis has a very different dynamic than having a student enter your classroom and your domain. Travelling in your car five separate times in the snow differs greatly from driving to and from work one time in a day.

There are a lot of considerations to opt to be a home-based teacher versus a center-based teacher. Most of us opt for home-based because the perceived rewards are better. We see a LOT of progress, even in one session. We get to work with the child one-to-one, establish rapport, and grow to care about the entire family. We see the child in their natural environment and can use that to our advantage.

This post is by no means a rant. Rather pointing out that there are a lot of good teachers dedicated to the field and many considerations they need to address in order to choose their location mode of service provision. Lately a lot of complaints have been surfacing the list-servs about the salaries that are demanded, attitudes and arrogance, and while I think they are well-founded in many situations, I think some praise is due to the good ones out there.

ABA versus RDI

2007-07-15T11:09:00.000-05:00

Looking through the links that have referred people to this site, often the search words "ABA vs. RDI" come up. I have a couple of comments on this.

Well, nothing is out there at this time comparing these two approaches. In order to compare the two, you would have to have a set of children in an ABA program that incorporates NONE of the guidelines outlined in RDI, and find a set of children in an RDI program that incorporates NONE of the principles outlined in applied behavior analysis and compare progress and outcomes for both of them. This, in my humble opinion, will never happen. Mostly because it is almost impossible to extricate what is ABA from what is RDI to what is Verbal Behavior to what is natural environment teaching. All programs incorporate behavior principles, whether they care to admit it or not. Positive reinforcement, negative reinforcement, chaining, shaping, are intrinsic to good teaching. A good program incorporates all of the aforementioned teaching strategies and embeds the principles of behavior analysis within them, both to teach, monitor, and analyze effectiveness.

Rather than perpetually attempting to disprove the effectiveness of ABA and constantly criticize the flaws of an ABA program, lets take a look at some of the skills that programs based in applied behavior analysis are not as adept in (e.g. relationship development, joint attention, body language) and lets identify programs and strategies that will address some of these concerns. Admittedly, ABA programs usually do not have a goal that targets joint attention. It is neglected, I think mostly because a way to teach it hasn't been analyzed, researched and supported. But that doesn't mean it can't be.

What I would like to see in the searches is rather than "ABA vs. RDI", things like "how to incorporate RDI into an ABA program and measure the effectiveness of strategies outlined in RDI." This is more realistic. Analyze the effectiveness of the strategy. I see RDI as outlining strategies to teach skills that are difficult for children with autism, and for teachers of children with autism, to address. I'm intrigued by some of the strategies, and incorporate them into my home-based programs. The difference is, we measure progress.

How do you measure progress in an RDI program? Identify what the goal is that you want to teach, and measure it. If your outcome is "the use of nodding to communicate assent or agreement non-verbally" now you have an outcome, that can be quantified and measured. How independent in contrived settings? How independent in contrived settings in the community? How independent in novel environments, with novel people, etc. It isn't the programs that are at battle at each other. ABA therapists don't inherently dismiss other programs. Let's just measure it. I would love nothing more than to have another strategy identified as effective to teach some of these challenging skills.

ABA programs should embrace new strategies that show promise for efficacy, and it looks like programs are starting to open their arms to incorporating other strategies from "perceived" opposing domains. But they aren't opposing, which is important to remember. What is important to identify is not the orientation of the creator, but the effectiveness of the strategy.

Parent and therapist relationships in home-based programs

2007-07-11T21:04:00.000-05:00

When a family is running a home-based program for their child with autism, dynamics are very different between family and teacher than they would be if the child was in a school/center-based program, and from my experience, it appears to be a neglected topic of discussion in the research, on forums, and in training programs.

Home ABA programs usually have high mandates of hours per week. For example, children that I work with have anywhere from 28-36 hours of ABA services in addition to related services of speech, PT and OT. This may mean that a family may have streams of therapist in and out of their home ALL DAY LONG. This has an impact on the family. While this is a program that they probably fought for, it doesn't make it easy to manage. The home starts to feel like a center.
- Family members may feel like privacy is violated.
- Freedom is somewhat limited (freedom to say what you want, wear what you want, scratch where you want).
- They may have people coming into their home, that while they respect their skills, may disagree with their lifestyle, dress, attitude, and yet need to welcome them into their home.
- Parents may also begin to feel ineffective, as there is a stream of people who may be more effective engaging their children, in constant presence.
- Simple acts in the home, conversations among members, parties, meals, may lose their intimacy, coziness, and privacy, all of which impact the family.
- Siblings may feel neglected, or left out, when a therapist shows up with a big bag of toys for their brother or sister. Additionally, some siblings may not want to have their own friends over fearing the need to answer questions about the therapy occurring.
- The parent is the only constant in the home, and is often left the role of providing communication among the various therapists about what has occurred that day. This can be exhausting and confusing.

These considerations need to be taken by therapists, respected, and therapists need to act accordingly to minimize discomfort when ever possible.

There are many factors that I have left out, that parents would be better at outlining, but I wanted to put it out there, that it is important to consider what the family is experiencing within this context of service.

Another difficult area is the personal relationship between the parent and the therapist. When an individual is coming into your home on a regular basis, you get to know them. You may start asking personal questions about how their weekend was. If that person looks sad, you may ask if they are okay. This happens in the therapist/parent relationship as well, and it is a VERY DIFFICULT and SHADY area. How far this is taken may make or break this relationship. It has hurt teams that I have worked on.

We are human, and we care about other people, but at some point, a line can be crossed, and the child's progress may suffer as a result. If a parent feels pressure to "take it easy" on a therapist, because she knows said therapist is not feeling well, is having personal problems, or is undergoing a stressful even (divorce, buying a house, death in the family) it inevitably compromise the relationship and service that is provided. It is difficult to keep it professional when a person is coming into your house (or you are going into theirs) but this line needs to be carefully attended to.

Several problems can occur when the relationship is compromised. One of the most important, is that if you start liking your therapist "as a person" too much, you may not be able to see that you need the opinion or input from another professional. Your vision may be clouded by the relationship that has been formed.

Additionally, as a parent of a child with a disability, you have your hands full. The parent shouldn't be responsible for caring about what is going on in the life of therapist. They need to focus on their child, their family, and maintaining order in the household.

It is easy to say "keep it professional" but difficult to do. Also, how appropriate is it to stick to just the professional chatter and not inquire about someone who looks like they are feeling under the weather. Tough spot. But important to acknowledge and attend to the issues that may come up and how certain relationships may be compromised.

Feedback and possible suggestions are welcome. Post them up!!

Families as Partners (FAP): New Early Intervention Regulations

2007-07-06T18:26:00.000-05:00

I recently went to a training addressing recent changes in early intervention service provision, and was surprised by some of the new regulations. Not surprised because I disagreed; rather surprised because I have rarely seen them implemented appropriately. Here is a brief review of these regulations, changes, and comments (of course).

FAPs overall goals are to support families: to help them learn skills to support their child's needs, to help their child learn, and to help the parents feel and be more capable to help their children.

These new regulation may have sprung from teams of teachers and therapists excluding the parent from the collaboration of their child's programs. It is now in the law that this collaboration, training, and interaction is documented. While it adds to our paperwork (therapists and parents included) it is increasing accountability of parent training and collaboration, which is always (really always) a good thing. Remember, it is EASIER to come in, work with a child, and leave. It is more challenging to teach a parent new to the field how to interact and teach their child. But it is the latter that will have more of an impact on the development of the child.

The receiver of the services is the family, not just the child. Emphasis is on the use of daily and natural routines. (some of us do this anyway, but certainly not all and definitely not most. They may say they do, but they don't.) The child is the reason for the service, but the child must be viewed within the context of the family.

Goals: These are no longer called goals. They are outcomes. What is written on the individualized family service plan (IFSP) should be exactly what the parent wants, not what the therapist prioritizes. So for example, a parent outcome might be "to play with his brothers and sisters." While this may hurt the eyes and ears of the behavior analyst, or anyone interested in quantifying outcomes in a measurable way, this is what the requirement is now. What this also means is that "Child will laterize tongue in order to produce the /l/ sound" is NOT a family outcome. This is a jargon filled term that is not considered acceptable for the IFSP.

This is challenging for the therapist. We now need to identify what is important to the family, and identify a way to meet that outcome, but read on, because it is not the therapists goal to meet the outcome, but rather the therapists/teacher's goal to help the parents meet the outcome.

Outcomes must be written without jargon. The family member should be able to understand the goals, as they should have written them.

Goals are written to include the child, the activity, the context, the time, and the family/member. For example: "James will use language to communicate his preference during dinner with his parents so that he can participate in meal time."

Training: Parents are no longer observers of therapy. Regulations stipulate that parents need to be involved in the sessions and taught how to elicit outcomes from their children. Recommendations for parents are that they are involved in at least 70% of the sessions of service their child is receiving. For example, if a child has three sessions of speech, two of those sessions should involve a parent or family member.

Responsibility is on two parties: therapist and family member. It is both parties that need to make the effort to do what is right for the child. This is a challenge for both parties. The therapist may not be skilled at training, comfortable working with parents, fluent in the parent's native language, etc. The parent may not be comfortable in the session with the therapist, feel effective as a parent, have other children that he/she needs to attend to, not speak the language of the therapist. To these difficulties, the answer is unanimously "work it out". As the priority is working with the child in the most effective manner, in the natural environment, with the family as providers. The therapist becomes the coach.

Documentation: In addition to the changes, there is written documentation of the services/training, that is provided. This documentation is again the responsibility of the provider and the parent. The provider (now called interventionist) must collaborate with the parent in order to identify activities that will facilitate progress toward the outcomes over the course of the week. Over the quarter, parents will document the therapist training, and their own response to the training. This is one of the first times that parents have the opportunity to provide feedback in a written statement regarding the quality of service they are receiving, which in my opinion is long overdue.

This was a brief review of some of the changes, but this is not what I personally seeing implemented. Rather parents are excluded from the collaborative process. It may LOOK like collaboration, but rather, it is the therapists outlining goals for the child, and letting the parent know about it, and how they could try to carry them over. This is placing the family in the heart of the services, which is where they should be.

However, this should not be interpreted to mean that the interventionists do not provide guidance in how to meet these outcomes. It is the interventionists responsibility to develop a program that will hopefully attain the outcomes outlined by the family. Let's see how it works out.