Tag Archive for: autism

Does Research Show that ABA is Successful in Treating Children with Autism?

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Yes—research does show that ABA is successful in treating children living with autism. As a matter of fact, since the early 1960s, the effectiveness of ABA based interventions has been very well documented particularly when helping children with developmental disabilities. Over 400 research articles were published between 1964 and 1970 alone and all have concluded that behavior analytic interventions demonstrated the most consistent results with individuals living with developmental disabilities. From the mid ‘80’s to 2010, there were over 500 peer-reviewed, published articles on autism and Applied Behavior Analysis.

Many families of children with autism are or are becoming familiar with the 1987 study published by Lovaas. That 1987 study was the first “group study” looking at children with autism receiving intensive ABA treatment (i.e., 40 hours per week) and children with autism that received 10 hours of ABA treatment or none at all.  In this famous study, Lovaas and his research team implemented many of the basic principles and techniques of behavior analysis into an early intensive intervention program for children with autism. After approximately two years of ABA based interventions, 47% of the children in his study made tremendous gains and were able to enter a typical first grade classroom without any additional assistance and scored in the average range in IQ tests when prior to the intervention these same children scored in the low range in IQ tests. Of the control groups, the children in the study that did not receive ABA interventions but only community supports, only one child was placed in a first-grade placement and scored average IQ.

While this study is over 30 years old, there are recent replications and research studies that indicate similar findings. While it’s beyond the scope of this post to go into all the research studies indicating the effectiveness of ABA programs for children with autism, ABA currently is widely recognized as a safe and effective treatment for autism.  It has been endorsed by a number of state and federal agencies, including the US Surgeon General and the New York State Department of Health. And for that reason, the use of ABA principles and techniques has rapidly expanded in recent years as more studies demonstrate that these principles help individuals with autism live more independent and more productive lives.

Some Considerations and Strategies for Students with Autism in Classroom Settings

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When creating an educational program for students with ASD, each student’s unique characteristics present unique challenges for administrators and school support staff. An effective classroom must include a physical structure that enhances learning opportunities and instructional approaches that facilitate learning, language acquisition, behavior management, social skills, and academic goals. We can apply many of the basic principles of effective instruction that are used in within the general education classroom as we work with students with autism and Asperger Syndrome, however, there are certain strategies that have been proven to be particularly effective. These strategies provide structure and predictability to the learning process, allow students to anticipate task requirements and setting expectations, and teach a variety of skills across content areas in the natural environment, enhancing the likelihood of generalization.

Predictability and sameness are significant factors throughout student’s daily lives. One way to address these elements in the classroom is with “Environmental Supports”. Environmental supports help students organize the physical space in ways that help our students predict any changes in their daily routines or deviations from typical expectations that may take place during the school day; different activities or events, a substitute teacher, or fire drills. We can help students understand expectations, and in general, make sense of their entire environment. Researchers have defined environmental support as “aspects of the environment, other than interactions with people, which affect the learning that takes place”. Examples of environmental supports are: Labels, Boundary settings, Visual schedules, Behavioral-based education tools, Activity completion signals, Choice boards, and Waiting supports.

All of these environmental support strategies are a simple yet effective way to help a student respond appropriately in their day-to-day activities throughout their school day. Environmental supports can be effectively utilized across all environments and all settings to help support individual with ASD. Additionally, environment supports have been shown to increase student independence, and help stimulate language.

The physical organization of the classroom can be a crucial element for them enhancing success. Structure and predictability facilitate the students understanding of the environment, which can help decrease worry or agitation the student might have. This is really important for students with autism who tend to react negatively or really that difficult time with changes and unsent uncertainty in their environment. Something as simple as labeling furniture and objects in a classroom can have numerous benefits for students with autism; label boxes or containers with visual representations such as icons or hand-written labels. Students can then be taught to match the label on the container to the label on the shelf, allowing independents in retrieving or returning an activity to its appropriate place in the classroom.

Again, we want to emphasize that each student is unique and the strategies used need to reflect their unique needs.

IS ABA therapy covered by my insurance

What is ABA (Applied Behavior Analysis)?

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Applied Behavior Analysis is a scientific approach to understanding behavior. Behavior Analysis is a theory with principles and laws that are derived from research. All of the practices in Applied Behavior Analysis are derived from basic research. ABA is considered an evidence-based practice, which means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. When such principles and laws are put into practice, it is said that behavior analysis is being applied, behavior analysis helps us to understand how behavior works, how behavior is affected by the environment and how learning takes place, thus the term APPLIED BEHAVIOR ANALYSIS or ABA for short.

Simply put, applied behavior analysis is a science concerned with the behavior of people, what people do and say, and the behavior of animals. Behavior analysis attempts to understand, describe, and predict behavior – why is it we do what we do and how did we learn to do what we do? The goal is to increase behaviors that are helpful and decrease behaviors that are harmful or affect learning.

The years of basic research in Applied Behavior Analysis have given us many Laws of Human Behavior that we can apply to the treatment of children with autism.  ABA has its roots in behavior therapy since the 20th century. The earliest behavior analysis on children with autism spectrum appeared in the early 1960’s and 1970’s in the USA.  ABA requires implementation of established principals of learning, behavioral strategies and environmental modifications to improve and teach new behaviors. Applied Behavior Analysis is founded on 7 core dimensions.  This means that all interventions that are provided through ABA services should fall within these 7 categories.  The 7 dimensions are, Generalization, Effective, Technological, Applied, Conceptually Systematic, Analytic and Behavioral. Generalization is when skills and or behaviors occur in environments other than where they were taught. Effective interventions are monitored to evaluate the impact on the target behavior.  Technological procedures are described clearly and concisely so that others may implement accurately. Applied is when socially significant behaviors are selected. Conceptually Systematic interventions are consistent with principals demonstrated by literature.  Analytic decisions are data based. Behaviors targeted are observable ad measurable.

It is important to understand that Applied Behavior Analysis is not only limited to autism. There is a variety of populations and fields that ABA can be applied to. The interventions that have been developed based on ABA principals are used in every walk of life and every profession.  Different types of people use ABA in their jobs and in their lives. Parents, teachers, psychologists and these ABA principals can be used in education, weight loss, animal training, sports and within many other fields and activities.  The ultimate goal of Applied Behavior Analysis is to establish and enhance socially important behaviors!

What Constitutes Effective Intervention for Individuals with Autism? The National Research Council’s report on Effective Treatments for Autism Still Stands True

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In 2001, the National Research Council published findings effective treatments on Educational Interventions for Children with Autism from birth to age 8. The committee set out with the question “What are the characteristics of effective interventions in educational programs for young children with autism spectrum disorders?” The findings were published in a comprehensive book titled, “Educating children with autism.”

In answering the above question, the committee recognized that there were numerous articles written on autism treatment and that there were numerous treatment programs across the country claiming to be effective in helping children with autism. Treatments ranging from ABA-based programs to developmentally-based programs to diet-based programs or more idiosyncratic programs such as sensory integration. In order to base their recommendations on clear evidence of effectiveness, the committee ruled out treatment that did not base their statements on some form of data regarding the outcome of the children.

They took a look at over 900 articles written on the treatment of autism and also enlisted the assistance of ‘model’ programs currently in place for the treatment of autism.  These model or state-of-the-art programs were typically university or research ran programs who that enlisted the services of highly qualified professionals. Of the ten model programs selected, seven were from an applied behavior analysis framework, one was from a developmental framework, one was purely parent training, and the last was a combination of behavioral and developmental frameworks.

The committee listed key features seen as variables of effective programs in an effort to use this information from these state-of-the-art programs and translate it to publicly funded early education programs across the country and to begin some quality control.

The first characteristic identified as a key feature of an effective treatment program is that of early entry into a program.  When reviewing the information from these model programs and based on findings from the literature, the committee saw that the earlier a child is placed in treatment the better their chances of making gains.  Therefore, their first recommendation was that educational services begin as soon as a child is suspected of having an autism spectrum disorder highlighting the importance of early intervention. Early detection and treatment are key phrases often heard in the medical field and this is the exact same case when it comes to the treatment of autism.  So, early entry is recommendation number one.

Next, the committee looked at the intensity of these programs and what has been shown in the literature  to be an effective level of intensity. Their conclusion upon review of the information was that educational services include a minimum of 25 hours a week, 5 days a week, 12 months a year during which time a child is actively engaged. The word minimum in this recommendation is key as some children may need more than this minimum of hours given the severity of their symptoms or their resistance to treatment.

Additionally, the notion of active engagement is very important as the recommended number of treatment hours is not merely the number of hours recommended for a child to be placed in a treatment program, but the number of hours to child is actively learning while in the program.  This means that the child should not be just physically present in a treatment program, but that each and every hour of that program is designed in a way in which the child will learn for a minimum of 25 hours per week.

Another way of looking at this is if it was recommended that a child attend a special education program 30 hours a week, one would initially think that the recommendation for a minimum number of hours has been met. However, if, within these 30 hours, the child spends at least two hours a day playing alone in the playground, one hour a day eating lunch, a few hours a day in unstructured and unsupervised solitary play activities, and only two hours of actual teaching occurs within the school day, a child is left with only a 10-hour a week treatment program. And while play time is extremely important for any child, if a child does not yet have the skills to know how to play, how can the child be expected to interact with other children during these free play times without specific structured teaching?  So, it is important to look beyond the number of hours and actually look at what each hour of the treatment program will entail whether that be an ABA program, school-based program, or any type of recommended treatment program.  It’s imperative that a child be placed in a program where they can access the curriculum and where the teachers or therapists are actively engaging the child so as to capture each and every teaching opportunity and make it a worthwhile experience. There needs to be intensive teaching and learning occurring during a child’s time in an intervention program.

The committee actually described intensity as a “large numbers of functionally, developmentally relevant, and high-interest opportunities to respond actively.”  In other words, a child’s time spent in a treatment program should result in high levels of learning when it comes to the matter of reaching their educational goals. So, the higher the level of active engagement, the higher the intensity, the higher the change rate for steady gains.

Next on the list of key characteristics was the child to teacher ratio. The committee recommended that programs consist of sufficient amounts of adult attention in order for a child to meet their educational goals, either learning with one-to-one or very small group instruction. The decision of student-to-teacher ratio should be made, depending on the learning ability of the child rather than depending on the staffing needs of the program.  Therefore, if a child can learn in a small group of maybe two children and one teacher, then that should suffice; however, as is the case for many young children with autism, if the child cannot occupy their own free time in a constructive manner, redirect their attention when asked, or learn via observation of a peer, then the teaching instruction should be in a one-to-one manner, that is one teacher with one child.

The committee recognized the need for well-trained personnel.  The committee noted that all the model programs they reviewed were developed by persons with Ph.D.’s in autism-related fields and the programs were directed and implemented by teams of professionals who had extensive training and experience in autism spectrum disorders. It is so important that the person designing a treatment program for a child with autism has extensive knowledge not only in the field of autism, but hands on experience in designing effective programs.

Next, the committee recognized the notion of individualization. A key characteristic of these model programs was that of comprehensive, individualized treatment goals based on the needs of each individual child rather than a one-size-fits-all curriculum for all the children in the program. The curriculum or individualized plan developed for each child should be based on their own personal strengths and weaknesses.  The goals for each child should also focus on the development of a child’s social and cognitive abilities, their verbal and non-verbal communication skills, adaptive or self-help skills, and the reduction of behavioral difficulties using more positive behavioral approaches rather than punitive approaches.

The second part of this recommendation, that “goals “are frequently adjusted,” cannot be emphasized enough. While the initial curriculum and targets developed for a child may be individualized at the onset of a treatment program, it is critical that these goals and targets be reviewed routinely and adjustments be made when necessary.

And lastly, the committee recognized the important role parents have when it comes to the effectiveness of treatment programs. A key characteristic amongst all model programs was their emphasis on parental training and involvement in the program. The involvement of parents is a very valuable tool in the treatment of autism because children spend most of their time with their parents; therefore, parents must play an active part in the treatment team so as to continue where the formal treatment sessions end. With parents as active participants of the program, a child will always be in a consistent environment where their skills can be generalization generalized and maintained.

Using Structure and Scheduling for Your Child and Taking Much Needed Time for You

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When you arrive home with the kids after school and work, the first thing you may want to do is relax!  Turning on the television for your child, letting her watch a movie, or allowing her to engage in her repetitive behaviors to her heart’s content is very tempting.  You have had a long day and rest is probably the first thing you would like to do.  Allowing these things just discussed though should be kept to a minimum and used as “earned” activities or used in emergency situations (i.e., when you just can’t take it anymore!).

So, what do you do instead?  When do you get “you” time?  First, focus on creating structure for your child during these down times.  Structure and routine are so important for children with autism. They are important for just about everyone but when it comes to children on the autism spectrum, they really thrive on routine and structure. You establish predictability with structure and routine and it can also help with meltdowns.

Create a visual schedule for your child for the evening routine using printed out photographs which you can Velcro in order to a piece of paper (a laminated paper is best).  A child can, by following clear pictures, recognize the order and importance of daily activities.  This reduces stress and anxiety because they know what to expect and what will be happening next. For example, you may allow 15 minutes of free play time, then homework, then dinner, then bath/shower, then bedtime routine activities, then bed.  It allows your child to see what to expect for the evening and also guides you as the parent, reminding you each evening what the structure should be.

What if your child does not follow visual schedules independently?  That’s okay!  It may take a few days, or even a few weeks, but after you guide them through the schedule each night, using a timer to signal the end of each activity, and guiding them to take off each picture as it is completed, they will learn to follow the schedule themselves and become independent before you know it.

Final tips: Be sure to include fun things that your child likes on the schedule, not just work activities and boring nightly activities.  Sometimes let them choose the activities during certain times (e.g., bedtime routine activities).  Lastly, be sure that when your child has successfully completed their schedule and is successfully in bed, do something good for you!  Enjoy that piece of cake that’s been sitting in the refrigerator or that glass of wine you’ve been waiting for all week.  Watch a movie with your partner.  Now it’s you time!

What should you do IN RESPONSE to your child engaging in challenging behavior?

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Remember those four reasons why people may engage in challenging behaviors discussed in the previous post?  People may want attention from other people, may want something, may want to get out of something, or may enjoy how the behavior feels.  If you haven’t already read it, we suggest reading the prior post so the information below is as useful as possible.

This post will focus on reactive strategies, based on the reason your child is engaging in the particular challenging behavior.  In other words, what should you do in response to your child engaging in the behavior?  This is probably the most stressful for parents as they may wonder if what they are doing is right.  They may wonder if they are hindering or helping their child.  Hopefully we can provide some guidance.

If your child engages in a particular challenging behavior to get something that he/she wants, it is important for him to learn that his behaviors do not lead to getting what he/she wants.  You should avoid giving them what they want when engaging in the problem behavior, and even after the behavior ends.  The child should only be allowed to get what they want if he engages in a more appropriate behavior, which we will discuss in a future post. This can be difficult for parents as giving the child what they want quiets them down and relieves much of the stress in the home or community setting.  The problem is that your child will learn this connection and continue to engage in this behavior in the future when they want to same thing. It will become a repeated cycle.

If your child engages in a particular challenging behavior to get out of something, such as homework or eating dinner, it is important to not allow him to get out of the situation until they engage in a more appropriate behavior.  If the child hits and screams while doing homework, it is important to follow through, require them to complete a few more problems without hitting and screaming, and then they can leave.  More appropriate behaviors to get out of doing things they don’t want to do will be discussed in future posts.

If your child engages in a particular challenging behavior to get attention, you should avoid providing attention to them until the behavior is not occurring or he engages in a more appropriate behavior to get your attention.  Providing attention only teaches them that this bad behavior leads to what they want.  This connection needs to be disconnected and the child needs to be taught more appropriate ways to get attention.

Last, if your child engages in some challenging behavior because it feels good, such as head banging, it is important to block this behavior so that this particular behavior does not provide the sensory satisfaction that your child is receiving (in addition to preventing them from doing harm to themselves).  You can physically block the behavior or there are many devices created for this purpose.

Stay tuned for a future post providing suggestions for what to teach your child to do instead of engaging in the bad behaviors they currently know will get them what they want.  Just reacting how we have described above will not teach new, appropriate ways to get what they want.  Teaching a new, more appropriate behavior is the key to decreasing challenging behaviors.

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What approach should caregivers take with challenging behaviors?

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Challenging BehaviorsManaging challenging behaviors can be quite stressful.  Most of the time, parents just do what they can to get through the situation with as little fuss and fighting as possible.  Unfortunately, this often times involves strategies that may be counterproductive, increasing the chance of these behaviors occurring in the future.  If the goal is to decrease these behaviors in the long run, there are specific strategies to use based on why the behavior is occurring.  Not all behaviors should be treated the same.  These strategies that we will discuss below and in future posts may not always be the first strategy a parent would think of, we do recommend consultation with a behavior analyst who can provide a treatment plan and provide support for you and your family along the way.

In general, it is important to plan for a) alternative behaviors to teach your child to engage in instead of the behaviors they currently engage in during specific situations, as well as b) how to handle behaviors in the moment when they are occurring.  When planning for these strategies, it is crucial to always think about why your child is exhibiting the particular challenging behavior.  There are four reasons that people engage in maladaptive behaviors, to get something they want, to get attention from someone, to get out of a situation, and to get sensory feedback from the behavior itself.  We will briefly review these four reasons in this post.

Children often engage in maladaptive behaviors to get something they want.  For example, a child may want a cookie out of reach in the kitchen, so he screams in the kitchen, hitting his head until someone comes in the kitchen and offers what they can until he or she gets what they want.  The child learned that screaming and hitting his head is an effective way to get a cookie.

Children also engage in maladaptive behaviors to get attention from others.  Have you ever been talking with your partner and your child starts screaming or engaging in other bad behaviors?  This may be because he or she wants your attention, for you to pay attention.

A very common reason why children engage in challenging behaviors is to get out of things.  Imagine a child eating dinner and he starts throwing his food and hitting their caregiver.  The caregiver says, “okay, okay, all done,” and allows the child to leave.  The child learned that throwing and hitting is an effective way to get out of eating.

Lastly, children diagnosed with autism engage in challenging behaviors sometimes because they like how the challenging behavior feels.  Screaming, pinching their bodies, pulling their hair, banging their heads on hard surfaces are all behaviors that may serve some sensory need.  It is important to distinguish this from any of the other reasons previously discussed before determining how to react and what to teach instead.

Take some time to think about your child’s challenging behaviors and why he or she may be engaging in them.  Stay posted for future posts outlining strategies for how to react to these behaviors and what to teach your child instead, based on why they are engaging in the behavior.

What have been your specific challenges?

What is Autism?

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Heartbreak and Help. No parent is fully prepared for the diagnosis of Autism. Some react with denial, others with fear. Most are confused. “What is Autism?” “Is there a cure?” “ What will our lives be like?” “Why my child?”

Let’s start at the beginning. What is Autism?

Autism Spectrum Behavior (ASD) is a disorder that usually appears by age 2 to 3. It cannot be defined in one tidy box but rather in a range of non-norm behaviors that involve social skills, repetitive actions, speech and nonverbal communication, and often difficulty coping with sights, sounds and other sensations. The intensity can be from mild to severe.

It’s overwhelming to realize that life with a child impacted with Austin will be very different than had been expected. Around the clock, a special-needs individual presents many challenges, the biggest of which is making sure your child lives up to his or her potential. What to do? Let’s start with…

A basic toolkit for parents:

  • Learn to be the best advocate you can be for your child. Be informed. Take advantage of services in your community.
  • Feel. Yes, it’s okay to express your feelings – be it anger, grief, or guilt. The key is focusing the pain towards the disorder and not those you love.
  • Do NOT allow autism to take over your life. Create quality time with your loved ones and…
  • Appreciate the small victories your child achieves. Love your special needs child for who he or she is rather than what others think they should be.
  • Get involved with the Autism community. Don’t underestimate the power of “community”, the comfort and support of others who face similar obstacles.

LeafWing Center: For over a decade, LeafWing Center has provided services for individuals with disabilities. We combine the expertise of Behavior Analysts, Marriage and Family Counselors, and Family Therapists, and Behavior Therapists, to help those in need, and their families, to live a fuller life.

The LeafWing Center blog will provide regular features on Autism – ranging from research developments, to treatment methods, to family survival strategies. Our purpose? To let you know you are not alone. Hope is within reach.

World Autism Month

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April is World Autism Month

Every April, Autism Speaks kicks off World Autism Month beginning with UN-sanctioned World Autism Awareness Day on April 2.Joined by the international community, hundreds of thousands of landmarks, buildings, homes and communities around the world, light blue in recognition of people living with autism. Autism-friendly events and educational activities take place all month to increase understanding and acceptance and foster worldwide support.