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Different Roads to Learning

  • January 28, 2022

    A Review of Promoting Functional Communication Within the Home

    By Different Roads
    This month’s ASAT feature is a review of Promoting Functional Communication Within The Home ( Bondy, A., Horton, C. & Frost, L.) by Kaitlyn Evoy, BA, and  David Celiberti, PhD, BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

    The ongoing COVID-19 pandemic has created an abrupt and enduring disruption to the educational programs of countless children with autism spectrum disorders (ASD) and with little preparation, placed parents in a primary instructional role. For any number of circumstances, such as outbreaks in their communities, parents are often required to assume or resume this role. We applaud Andy Bondy, Catherine Horton, and Lori Frost for writing this comprehensive and useful article at a time when so many were struggling with creating meaningful experiences for our learners and their families. To put the authors’ swift effort in perspective, their article was published online on May 12, 2020 and was accessible in PDF form at no cost to the reader. The authors purposefully used language to promote understanding by all readers by removing unnecessary jargon, using abundant practical examples, and explaining complex concepts in accessible ways.

    These authors highlight nine critical communication skills as a response to the COVID-19 crisis and the subsequent increased time children were/are spending at home. These critical communication skills encompass both speaker and listener roles and were highlighted because of their relevance and necessity for everyday functioning.  Furthermore, helping children to use these skills reliably and competently may lessen frustration and reduce or eliminate the need to engage in other ways to get those needs met (e.g., challenging behaviors).

    The authors describe and elaborate upon each of the nine skill areas. The summaries include the rationale for prioritizing that skill, useful teaching strategies, commonly faced problems, and possible solutions. The article reviews the process for assessing current performance levels for the nine skills and offers tips to caregivers through this effort. For assessment of present levels, a checklist is provided with specific examples of phrases and/or subcategories. For example, the authors separated “request reinforcers” into edibles, toys, and activities. The skill of responding to directions is broken down into the two distinct areas of visual and oral directions. Authors elaborate on these two areas and provide examples for each (i.e., “come here,” “stop,” and “sit down” for oral directions). The tips given to parents and other caregivers include prioritizing activities and routines that are of the highest need for an increase in functional communication and using these core areas as a basis for overall instruction. In short, the authors emphasize targeting most immediate needs as a means to improve overall communication skills.

    Nine Critical Communication Skills

    1. Requesting Reinforcers: We wholeheartedly agree with the authors that the skill of requesting reinforcers is of paramount importance. The authors suggest that parents should start with discerning what is reinforcing for a child before working on this skill. Rather than conducting preference assessments finding one item or activity on its own, the authors recommend trying combinations of items to create more motivating rewards. They also recommend re-creating situations as needed, setting realistic goals, raising expectations carefully, and using different levels of motivating reinforcers in an intentional and strategic manner. For instance, if the task is routine and not challenging, the reinforcer should not be the most highly motivating one.
    2. Requesting Help/Assistance: The authors aptly note that this skill is one that all children and adults will need in their lives. They recommend increasing levels of difficulty over time to promote mastery. Start with tasks which are easier to solve. When the child can ask for help in less challenging situations, increase the level of difficulty. It is important to gauge their frustration levels and be willing to decrease the demand when warranted. As stated above, the authors remind readers to re-create situations to create clean learning opportunities rather than address them amidst a challenging behavior.
    3. Requesting a Break: Asking for a break when overwhelmed or tired is another critically important skill for all of us, and we appreciate the authors inclusion of this skill. When working on newer, challenging skills with your child, it is essential that they can ask for a break when needed. This can decrease physically aggressive behavior, self-injurious behavior, and other problematic behaviors. The authors recommend that parents should work on this skill before frustrations reach crisis levels. Once you have an understanding (baseline) of tasks/work time your children can consistently do without needing a break, you can slowly increase the number of tasks and/or work time. Perhaps one of the most important points that the authors raise with respect to break requests is that parents should not rely on their hunches as to when a break is needed and provide one in the absence of a direct request, but rather give children the tools to request a break themselves on their own terms.  In addition to the suggestions offered by the authors, we would recommend working towards a more elaborate response (“I need a break. I am tired.” or “Can we stop? My stomach hurts.”).
    4. Rejecting: We agree that learning to reject appropriately is an essential skill and can be critical in decreasing maladaptive behaviors. Being able to reject, refuse, or withdraw consent is another important skill that will be needed throughout one’s life. If children are not able to reject situations, activities, or items, this can lead to frustration and challenging behavior. The most important thing to remember when teaching this skill, is to always honor their rejection.  Furthermore, new skills such as this require abundant and consistent reinforcement. As with the teaching of other communication skills, caregivers can increase the difficulty by including situations, activities, or items that have a higher chance or severity of dislike.
    5. Affirming/Accepting: As with rejection, affirmation is a communication skill needed for everyday life. The authors were right to include this in this resource. Answering “yes” is also an important communication skill. This is especially true when options are difficult to show or when situations arise that a caregiver can’t prepare for ahead of time. When teaching children to differentiate between “no” and “yes,” try teaching them separately before giving them both as options.
    6. Responding to “Wait” or “No”: This is particularly relevant during the pandemic given that many preferred activities may be less available during times of social distancing. We commend the authors for including this challenging, yet inevitable skill in their article and for making the important distinction between learning to accept delayed versus denied gratification. Learning to wait is a challenging skill, particularly when the duration of time needed to wait is not clear. Although difficult, waiting and accepting an unwanted answer are important skills in situations that children will often encounter. This skill can be difficult for caregivers to increase complexity.  The authors recommend predicting negative responses, coping with them, and being willing to reset the challenge. The authors also highlight three essential elements to consider, and we refer the reader to the article to learn more.
    7. Following Directions: In addition to the obvious benefits of being able to follow directions, there are also possible risks when children cannot follow directions, especially in safety situations. To promote skill acquisition, the authors recommend starting with tasks that are more desirable for the child (e.g., accessing a favored item).
    8. Following a Schedule: Although the above skills involve the expression of communication, following a schedule is necessary and can be an essential tool for creating a predictable environment, as well as for learning to tolerate changes in those schedules. Visuals help children anticipate expectations and learn independence. The authors also discuss how schedules can vary in terms of the number of tasks/activities as well as descriptive factors. For example, scheduled items can be represented by physical objects, pictures, or words. Once children are able to follow a schedule, parents can introduce planned changes (the authors refer to this as a “surprise”) in order to increase tolerance of unexpected changes that naturally occur.
    9. Transitions: We appreciate the decision to discuss transitioning as an essential functional communication skill. Transitioning between activities and coping with unexpected transitions can be particularly challenging for children with autism. Parents can prepare children for transitions, but not all changes can be predicted. Like many of the skills noted above, frequent practice is needed. The authors suggest that parents showcase upcoming reinforcers as a way to promote successful transitions across activities. This recommendation may be a helpful strategy for many families particularly when the next activity is not inherently rewarding.

    Final Thoughts

    Parents and other caregivers need support, guidance, and accessible information in providing instruction to their children in the home environment. The COVID-19 crisis disrupted children’s lives, including therapies targeting functional communication. This comprehensive, useful, and easily accessible article aids in breaking down the main areas of functional communication and actionable steps for caregivers to take to work on each of these areas. Although beyond the scope of this brief article, we would also like to draw attention to a few other skills such as initiating and responding to greetings; and expressing feelings, discomfort, fatigue, and sickness.

    As a resource, this very accessible article is valuable to other stakeholders besides the target audience of caregivers. Teachers, therapists, and other educational staff can use these critical functional communication skills to assess current overall functioning and target areas for improvement.  Now that onsite service delivery has resumed, the advice given to caregivers throughout Bondy, Horton, and Frost’s article bears much relevance for education and other therapies in the school environment.

    Citation for this article:

    Evoy, K., & Celiberti, D. (2022). Review of Promoting functional communication within the home. Science in Autism Treatment, 19(1).

    About The Authors

    Kaitlyn Evoy, BA is a special education teacher with a Bachelor’s degree in Special Education, and she holds a Learning Behavior Specialist-1 Certification in Illinois. She obtained her Bachelor’s degree from Lewis University in 2014, and she is currently studying Autism and Other Pervasive Developmental Disorders at Johns Hopkins University. Kaitlyn is drawn towards the study of evidence-based practices and their execution in classroom environments. She is an Extern at the Association of Science in Autism Treatment focusing on dissemination to teachers and other educational support staff. 

    David Celiberti, PhD, BCBA-D, is the Executive Director of ASAT and Past-President, a role he served from 2006 to 2012. He is the Editor of ASAT’s monthly publication, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993 and his certification in behavior analysis in 2000. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis (ABA), and early childhood education. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to ABA at both undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

     

  • January 26, 2022

    Working on the Front Lines of Autism Care

    By Different Roads

     

    By: Stephanie Tafone, M.A., P.D., Behavior Intervention Specialist at Eden II Programs 

    Working on the front lines of Autism care in a residential facility is both rewarding and, at times, challenging. Although our residents depend on us in many ways to teach them how to complete day-to-day tasks, it is important for all staff to recognize and respect that our residents each have their own preferences and interests. Therefore, we always strive to let our residents make as many choices as possible (provided they are healthy choices that do not cause harm to anyone). Just because we as staff might complete a particular task a certain way does not mean it is the “right” or only way to do so. Recognizing and respecting residents’ choices can help avoid negative behaviors or frustration for our residents. Our goal is always to teach and foster independence and self-direction. 

    It is always important to build good rapport with our residents so we are in tune with their wants and needs, while also enabling them to better trust us, work with us, and learn from us. Unfortunately, with current staffing crises and funding cuts in residential care settings, one challenge we face is securing long-term, seasoned staff. This type of setting often suffers from a high turnover rate, which this is a matter that needs more global attention, as hardworking, dedicated, and experienced/trained staff are crucial for our population. 

    One of the biggest considerations we have on a daily basis, particularly during the global COVID-19 pandemic, is finding creative and entertaining recreational and leisure activities to keep our residents happy and actively engaged. Anyone can become restless and bored with nothing to do, and those with Autism are no different, which is why active engagement is one of our top priorities in a group home setting. When selecting activities, we strive to ensure that each resident’s preferences are considered and incorporated. This includes a combination of both community outings and in-house events/activities. Going into the community on outings can be challenging at times when unpredictable factors (e.g. noise, crowds, etc.) may trigger negative behaviors. However, we do our best to avoid triggering situations by researching and/or visiting the activity or location before our residents experience it in order to help determine if there are any barriers that will prevent it from being an enjoyable and successful outing for all. We also do our best to go prepared on each community outing with preferred items that can be used as a source of redirection and comfort if needed. For example, headphones to drown out noise if it gets too noisy, as well as preferred snacks or drinks if our residents get hungry or thirsty. In the residence, we also strive to think of creative leisure activities, such as dance or karaoke parties, Bingo nights, movie nights, baking, and arts and crafts. Having an enthusiastic and supportive approach, as well as using preferred reinforcers, helps to engage our residents in these activities and increase their interest level. 

    In addition to recreational and leisure activities for entertainment and socialization, day-to-day life in the residence is also a learning experience for our residents, as they work on a variety of individualized goals with their assigned staff. Examples of goals may include activities such as participating in a consistent exercise regimen, learning how to independently cook rice or make tea, learning how to independently count money and make purchases, and learning how to independently vacuum or clean one’s room. The selection of a participant’s goals is a collaborative process that involves input from parents/caregivers, input from the participant(s) if possible, and input from the management team at the residence. We strive to ensure that selected goals not only address a skill deficit, but are also aligned with the participant’s interests and will help the participant become more independent in daily living skills. Similarly, participants learn increased independence by participating in various chores around the house, such as setting the table for lunch and dinner, loading and emptying the dishwasher, and doing one’s laundry. Teaching many of these goals and chores can be accomplished through the use of a visual task analysis that breaks the task down into smaller components (i.e. individual steps), which are each depicted in visual images. Visuals are a very helpful teaching technique for those with Autism, who often struggle significantly with understanding verbal language and oral directions. It is also helpful for learning, especially in the initial stages, to use a preferred reinforcer to reward correct completion of steps. In the beginning of learning a new goal or chore, one step may need to be taught for a number of consecutive days until it is mastered and the next step can be taught. 

    Overall, working in a residential setting has been a great learning experience and we know that our work has had, and continues to have, a significant influence on our residents’ lives, which is very rewarding for all staff. 

    About the Author: 

    Stephanie Tafone, M.A., P.D. earned her B.A. in Psychology from St. John's University before going on to earn her M.A. and Professional Diploma in School Psychology from Kean University. She is currently in the process of completing the requirements to obtain an Advanced Certificate in Applied Behavior Analysis as she pursues national certification. For the past ten years, she has been working with both children and adults with disabilities. She currently works as a behavior intervention specialist at a residential facility serving adults who have been diagnosed with Autism Spectrum Disorder. She also works as a school psychologist serving children with various diagnoses and disabilities, as well as an adjunct professor for courses pertaining to Applied Behavior Analysis, Autism, and Intellectual Disability. 

     

  • January 19, 2022

    "This Is Hard"

    By Different Roads

    "This is hard" is a statement I often hear from families both in the midst of intervention, and pre-intervention during the assessment phase.

    Families without support and services find it hard helping their Autistic child navigate the world, and families in the midst of therapies and interventions find generalizing them to be hard.

    It's hard to consistently generalize an intervention plan outside in the home, on the weekends, on Sunday at the grocery store, on vacation at Grandma's house, or at 6am on a Saturday when your child only slept 2 hours.

    But its also hard to supervise/monitor your child 24-7, to break up sibling fights all day long because your child can't share, to find quality childcare options when your child is highly aggressive, or to figure out if your child is ill or sick when they can't tell you.

    Both are hard.

    It is rarely a discussion of hard vs easy, and much more common is a decision regarding which "hard" is acceptable. Yes, toilet training is hard work. On the flip side, changing an 8 year-olds diaper isn't exactly easy. Nor is it easy to afford to buy diapers for that many years.

    Yes, teaching your child to use utensils instead of eating with their hands is hard. On the flip side, restricted diet and issues around mealtimes can be made worse if the child will only eat finger foods (typically, starches and carbs). That is also hard.

    Yes, it is hard to consistently follow a Behavior Plan when in public with your child. On the flip side, being asked to leave locations, having friends ask that you not visit, or being scared someone will call the police on your child during a public outburst, is a hard reality to live out.

    You have to decide which "hard" to accept.

    I intentionally use the phrase "intervention plan" and not "ABA therapy", because maybe your child isn't receiving ABA services. Maybe you don't want that, or can't access it.

    But are they receiving Speech services? OT? PT? In special education at school? Attending an Autism preschool program?

    If so, these are all interventions designed to minimize developmental delays and target current deficits.

    Whatever kind of intervention your child participates in, there are a few components that tend to be the same across different therapies:

     

    1. Consistency. In order to be effective, the intervention must be applied consistently. Frequent staff turnover, frequently canceling appointments, or other issues like this can negatively impact results.

    2. Training must carry over to the home setting/caregivers. There is no way to generalize the intervention if you have no idea what it is.

    3. Caregiver Participation. In order for #2 to happen, the caregivers must be willing and available to participate in the intervention/treatment plan.

    4. Focus on progress vs miracles. Progress can be slow, it can be up and down, and at times it can mean treading water. Sometimes an absence of regression IS progress. If you have sky high expectations of the intervention process, this can cause "provider hopping" where families move from one agency, provider, or intervention to the next looking for magic. That just is not how quality, ethical treatment works.

    5. Individualized Intervention. It doesn't matter if your child receives 30 minutes of Speech each week, or 15 hours of ABA. Are the treatment goals and the teaching methodology suitable and appropriate for your child? "Cookie-cutter" intervention is when treatment is applied in a lazy, vague, and generic way across multiple clients. In order for intervention to be effective, it must meet your child where they are and incorporate their unique interests and motivation(s).

    About The Author: Tameika Meadows, BCBA

    “I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.

    From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”

    This piece originally appeared at www.iloveaba.com. 

  • January 12, 2022

    A Parent's Guide to ABA Facilities

    By Different Roads

    When a child first gets diagnosed with Autism, parents are often overwhelmed. A good doctor will give a prescription for ABA therapy as well as other necessary therapies such as Speech, OT,  PT, Feeding, etc. However, of those therapies, the one that is usually not familiar is ABA. A simple Google search or, even worse, joining a Facebook group is going to lead a parent down a path full of controversy, fear mongering, and misinformation. This will often leave parents very leery of any ABA facility they meet with, or completely turned off from the best medically-proved therapy for young Autistic children.

    So I created a list of questions for parents to ask potential ABA facilities to find the best match for their family. After all, they’re entrusting you with their child for hours upon hours. The child is often non-verbal and unable to tell you how their day was. So a parent must trust the facility completely. In writing this list, I also kept in mind the warnings/worries of abuse touted by certain internet groups, in hopes to appease them should they come across this list. Parents can use this list in their ABA search and clinics can have this list on hand for parents, and their potential answers ready.

    1) Do you force eye contact or stop unharmful stims? This is one of the top citations of “abuse” from certain internet groups. Some parents don’t want to force eye contact and view their child’s non-harmful, non-disruptive stims as a beautiful part of their personality.

     

    2) How do you avoid meltdowns? Knowing that you are going to avoid meltdowns will help parents feel far more comfortable about sending their child.

     

    3) Do you ever withhold food? Even neurotypical kids are picky. Us “Autism Parents” are usually self-conscious about the fact that our kids survive on pretzels and Pediasure. Telling a child “No chicken nuggets until you’ve finished your green beans” will probably mean a hungry child, and an unhappy parent.

     

    4) How do you handle naps? With the diagnostic age of Autism getting increasingly lower, children are starting ABA before they are ready to phase out of naps. Having a plan in place for nap time will make a parent know their child is getting their needs met.

     

    5) What are your parent training session requirements? ABA is a fantastic therapy, but without the parents upholding it at home, it’s pretty hard to fully instill the methodology and give the child all the help they deserve Parent training lets parents feel more involved in their child’s therapy which is essential!

     

    6) What are the requirements of your staff? Parents researching ABA are shocked to hear you only need a high school diploma to be an RBT. If you have a higher standard for your staff of any sort, parents will feel more comfortable sending their children to your facility.

     

    7) What will my child’s daily schedule look like? Knowing what a child does throughout the day helps a parent make the decision for what works best for their child.

     

    8) How do you incorporate academics? Many parents are choosing between ABA and Preschool. Being able to tell parents your ABA facilitates some sort of Academics (We focus on writing, the alphabet, etc) will make the decision far easier!

     

    9) How do you prevent harmful stims? Parents recoil at the thought of their child being restrained. What are your rules around touching kids? How do you keep our child from harming themselves, or anyone else?

     

    10) How do you communicate with me? My child can’t tell me about his day. So I need his therapists to do so. What are you doing to tell me about his day? What he ate? Did he name? Diaper changes? Injuries? The more communication, the better!

     

    This list isn’t comprehensive. It won’t work for every facility. However, these are the questions I have found most parents want the answers to in order to find the best facility for their kids. And to feel they aren’t sending their children to an “abusive” environment.

     

    About the Author:

    Cassie Hauschildt is the mother of her Autistic son, Percival, who was diagnosed at 20 months old. Since his diagnosis, she has become an advocate for autistic children. She dedicates her time to mentoring parents of autistic kids through the tough first few months post-diagnosis. She also is trying to get rid of the negativity surrounding ABA therapy. She does this through humor, while using real talk, on her TikTok @AnotherAutismMom. She also runs “The Dino and Nuggets Corner” Facebook Group.

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