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Autism and Motivation in Children

Autism and motivation in children can be a challenging combination. Motivation can be difficult for many people. Plenty of us struggle to exercise regularly or eat well. This is true even though these lifestyle changes could likely make a large difference in our health and consequently, our quality of life. Motivating children with autism also requires empathy and patience.

Children with Autism Spectrum Disorder (ASD) are not always motivated to master basic tasks or life skills in the same ways as neurotypical children. Autism and motivation in children can seem incompatible. Or, perhaps your child is highly motivated to hyper-focus on certain tasks, just not the tasks you’d like them to choose. Motivating children with autism can be a struggle until you identify the specific factors that inspire your child.

Motivation

Each child with ASD may be motivated by different:

  • activities
  • enviroments
  • people
  • rewards
  • perceptions

It is important to spend time learning what is motivating to your autistic child. Then you can practice applying this information to help your child grow in their own motivation.

Intrinsic Motivation and Autism

In Applied Behavior Analysis (ABA) we sometimes discuss motivation by categorizing it in two ways—intrinsic and extrinsic. Intrinsic motivation refers to motivation that would be described as coming from within a person. That is, you do something because you like it.
For example, the prima ballerina rehearses 8 hours a day because she wants to be able to perform exceptionally. Autism and motivation in children can show up as an inner drive to accomplish a task or observe an activity. Your child may love cars and they are highly, internally motivated to sit by a window and watch traffic drive by or play with their own toy cars for hours.

Extrinsic motivation on the other hand refers to motivation that comes from others or our environment. For example, some employees in a manufacturing company may show up to work on time to avoid getting in trouble with the boss. Children with ASD may be motivated to put away toys with the reward of their favorite snack or TV show.

Behavior is affected by many influences. Autism and motivation both influence behavior. By observing patterns in your child’s choices, you can learn the best ways to encourage them to grow and learn new habits.

Autism and Motivation

Intrinsic and extrinsic motivational mechanisms apply to children living with ASD. Many children with autism are not interested in doing all of the things that we would like them to do. Motivating children with ASD to accomplish tasks or master skills is frequently different from motivating neurotypical children.

Some of our children on the spectrum may choose to engage in repetitive play or ignore others. Autism and motivation in children may look like your child only engaging in things that they find interesting. When this free time is interrupted, or when they are asked to move their attention to something or someone else, they may suddenly appear unmotivated to learn or disinterested. In some cases, other challenging behaviors can occur if we follow-through with our demands.

Factors that influence autism and motivation can be observed in your child. If you find your child happily engaging in an activity, take note of the type of activity and the environment. Certain types of play, food or stimuli may be preferred. For example your child may really enjoy playing with marbles. It may be helpful to ask the following questions to determine what is motivating children with autism. Does your child:

  • Suddenly stop enjoying or engaging with this activity if there is noise or music in the background?
  • Enjoy this activity more when they have different paths and features for the marbles to follow?
  • Like to play with marbles independently of peers, or do they enjoy others joining them?

Environmental inputs can influence children with ASD so strongly that motivation is impacted. An autistic child’s sensitivities are key factors in determining how autism and motivation should be approached to achieve the most effective outcomes.

Positive
Motivating Autistic Children: Intrinsic Motivation and Extrinsic Motivation Techniques

Without motivation, the learning process may be significantly slowed down or made to feel impossible. For this reason, every effort is made to increase a child’s motivation to learn at every stage of an ABA program. Ample time is spent finding out what things a child likes. Therapists will use reinforcer surveying or reinforcer sampling to determine the things that will motivate your autistic child long enough to learn. It is also important to learn what is not motivating to your child, so that you can avoid those challenges.

Motivation in an intensive Applied Behavior Analysis program may initially take the form of something extrinsic, such as being rewarded with their favorite foods, candies, or activities. Frequently, verbal praise and high-fives or anything that a child may find enjoyable can be used for positive reinforcement.

However, it is hoped that over time, this motivation will transition from extrinsic to intrinsic such that a child will engage in learning for personal joy and accomplishment. For example, a child may be motivated to build a block house because they are looking forward to feeling happy with the completed structure. To lead to this intrinsic motivation, rewards like candy or other foods can be systematically reduced while more internal, natural rewards take their place.

Motivational words

Motivating Children With Autism

Motivating children with autism is a multiple step process.

  1. Identify what your child enjoys on their own or is already intrinsically motivated to engage with or accomplish.
  2. Select rewards and positive reinforcements for your child to use as extrinsic motivation.
  3. Gradually, reduce the extrinsic rewards as you notice your child learning a positive habit or experiencing more positive feelings about accomplishing activities.
  4. Communicate with your child about the changes they are experiencing. Motivating children with autism gains momentum as your child feels supported and acknowledges their own positive progress.

Using extrinsic rewards is a common concern that others may have when considering an ABA therapy. However, professionals leading ABA programs plan ahead and strive to transition from extrinsic into more intrinsic forms of reinforcers over time. The use of transitional positive reinforcements, or extrinsic rewards, is an important factor in a child’s program that creates more positive associations with new behaviors.
If you are struggling to identify what motivates your autistic child or you would like to see changes in what motivates your child, it may be a good time to reach out to a trained professional. You can get help evaluating the influences of autism and motivation in your child. An ABA professional can also create a program tailored to your child to help them make progress towards motivational goals.

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

ABA-based therapy can be used in a multitude of areas. Currently, these interventions are used primarily with individuals living with ASD; however, their applications can be used with individuals living with pervasive developmental disorders as well as other disorders. For ASD, it can be used in effectively teaching specific skills that may not be in a child’s repertoire of skills to help him/her function better in their environment whether that be at home, school, or out in the community.  In conjunction with skill acquisition programs, ABA-based interventions can also be used in addressing behavioral excesses (e.g., tantrum behaviors, aggressive behaviors, self-injurious behaviors). Lastly, it can also be utilized in parent/caregiver training.

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

Agencies that provide ABA-based services in the home-setting are more likely to implement ABA services similarly than doing the same exact protocols or procedures. Regardless, an ABA agency under the guidance of a Board-Certified Behavior Analyst follows the same research-based theories to guide treatment that all other acceptable ABA agencies use.

ABA-based services start with a functional behavior assessment (FBA). In a nutshell, a FBA assesses why the behaviors may be happening in the first place. From there, the FBA will also determine the best way to address the difficulties using tactics that have been proven effective over time with a focus on behavioral replacement versus simple elimination of a problem behavior. The FBA will also have recommendations for other relevant skills/behaviors to be taught and parent skills that can be taught in a parent training format to name a few. From there, the intensity of the ABA-based services is determined, again, based on the clinical needs of your child. The completed FBA is then submitted to the funding source for approval.

One-on-one sessions between a behavior technician and your child will start once services are approved. The duration per session and the frequency of these sessions per week/month will all depend on how many hours your child’s ABA services have been approved for—usually, this will be the number recommended in the FBA. The sessions are used to teach identified skills/behaviors via effective teaching procedures. Another aspect of ABA-based services in the home-setting is parent training. Parent training can take many forms depending on what goals have been established during the FBA process. The number of hours dedicated for parent training is also variable and solely depends on the clinical need for it. If a 1:1 session is between a behavior technician and your child, a parent training session or appointment is between you and the case supervisor and with and without your child present, depending on the parent goal(s) identified. Parent training service’s goal is for you to be able to have ample skills/knowledge in order for you to become more effective in addressing behavioral difficulties as they occur outside of scheduled ABA sessions. Depending on the goals established, you may be required to participate in your child’s 1:1 sessions. These participations are a good way for you to practice what you have learned from the case supervisor while at the same time, having the behavior technician available to you to give you feedback as you practice on those new skills.

As mentioned in the beginning, no two ABA agencies will do the same exact thing when it comes to providing ABA services; however, good agencies will always base their practice on the same empirically-proven procedures.

How do I start ABA Therapy?

In most cases, the first item required to start ABA therapy is the individual’s autism spectrum disorder (ASD) diagnosis report. This is typically conducted by a doctor such as a psychiatrist, psychologist, or a developmental pediatrician. Most ABA therapy agencies and insurance companies will ask for a copy of this diagnosis report during the intake process as it is required to request an ABA assessment authorization from the individual’s medical insurance provider.

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

The next step to starting ABA therapy is to contact an ABA provider whom you are interested in working with. Depending on your geographic location, ABA agencies exist in many cities across the United States. Your insurance carrier, local support groups, and even a thorough online search can help you find reputable and properly credentialed ABA agencies near you. Our organization, LeafWing Center, is based in southern California and is recognized for aiding people with ASD achieve their goals with the research based on applied behavior analysis.

Once you have identified the ABA provider with whom you wish to work, they should help you facilitate the next steps. These will include facilitating paperwork and authorizations with your funding source. Once the assessment process begins, a BCBA (Board Certified Behavior Analyst) or qualified Program Supervisor should get in contact with you to arrange times in which interviews with parents/caregivers and observations of your loved one can be conducted. This will help in the process of gathering important clinical information so that with your collaboration, the most effective treatment plans and goals can be established for your loved one. This process is referred to as the Functional Behavior Assessment (FBA) and is elaborated on in different blog posts on our website. With regard as to what can be expected once ABA therapy begins, please read our blog post titled: When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?

Autism and Motivation in Children

Autism and motivation in children can be a challenging combination. Motivation can be difficult for many people. Plenty of us struggle to exercise regularly or eat well. This is true even though these lifestyle changes could likely make a large difference in our health and consequently, our quality of life. Motivating children with autism also requires empathy and patience.

Children with Autism Spectrum Disorder (ASD) are not always motivated to master basic tasks or life skills in the same ways as neurotypical children. Autism and motivation in children can seem incompatible. Or, perhaps your child is highly motivated to hyper-focus on certain tasks, just not the tasks you’d like them to choose. Motivating children with autism can be a struggle until you identify the specific factors that inspire your child.

Motivation

Each child with ASD may be motivated by different:

  • activities
  • enviroments
  • people
  • rewards
  • perceptions

It is important to spend time learning what is motivating to your autistic child. Then you can practice applying this information to help your child grow in their own motivation.

Intrinsic Motivation and Autism

In Applied Behavior Analysis (ABA) we sometimes discuss motivation by categorizing it in two ways—intrinsic and extrinsic. Intrinsic motivation refers to motivation that would be described as coming from within a person. That is, you do something because you like it.
For example, the prima ballerina rehearses 8 hours a day because she wants to be able to perform exceptionally. Autism and motivation in children can show up as an inner drive to accomplish a task or observe an activity. Your child may love cars and they are highly, internally motivated to sit by a window and watch traffic drive by or play with their own toy cars for hours.

Extrinsic motivation on the other hand refers to motivation that comes from others or our environment. For example, some employees in a manufacturing company may show up to work on time to avoid getting in trouble with the boss. Children with ASD may be motivated to put away toys with the reward of their favorite snack or TV show.

Behavior is affected by many influences. Autism and motivation both influence behavior. By observing patterns in your child’s choices, you can learn the best ways to encourage them to grow and learn new habits.

Autism and Motivation

Intrinsic and extrinsic motivational mechanisms apply to children living with ASD. Many children with autism are not interested in doing all of the things that we would like them to do. Motivating children with ASD to accomplish tasks or master skills is frequently different from motivating neurotypical children.

Some of our children on the spectrum may choose to engage in repetitive play or ignore others. Autism and motivation in children may look like your child only engaging in things that they find interesting. When this free time is interrupted, or when they are asked to move their attention to something or someone else, they may suddenly appear unmotivated to learn or disinterested. In some cases, other challenging behaviors can occur if we follow-through with our demands.

Factors that influence autism and motivation can be observed in your child. If you find your child happily engaging in an activity, take note of the type of activity and the environment. Certain types of play, food or stimuli may be preferred. For example your child may really enjoy playing with marbles. It may be helpful to ask the following questions to determine what is motivating children with autism. Does your child:

  • Suddenly stop enjoying or engaging with this activity if there is noise or music in the background?
  • Enjoy this activity more when they have different paths and features for the marbles to follow?
  • Like to play with marbles independently of peers, or do they enjoy others joining them?

Environmental inputs can influence children with ASD so strongly that motivation is impacted. An autistic child’s sensitivities are key factors in determining how autism and motivation should be approached to achieve the most effective outcomes.

Positive
Motivating Autistic Children: Intrinsic Motivation and Extrinsic Motivation Techniques

Without motivation, the learning process may be significantly slowed down or made to feel impossible. For this reason, every effort is made to increase a child’s motivation to learn at every stage of an ABA program. Ample time is spent finding out what things a child likes. Therapists will use reinforcer surveying or reinforcer sampling to determine the things that will motivate your autistic child long enough to learn. It is also important to learn what is not motivating to your child, so that you can avoid those challenges.

Motivation in an intensive Applied Behavior Analysis program may initially take the form of something extrinsic, such as being rewarded with their favorite foods, candies, or activities. Frequently, verbal praise and high-fives or anything that a child may find enjoyable can be used for positive reinforcement.

However, it is hoped that over time, this motivation will transition from extrinsic to intrinsic such that a child will engage in learning for personal joy and accomplishment. For example, a child may be motivated to build a block house because they are looking forward to feeling happy with the completed structure. To lead to this intrinsic motivation, rewards like candy or other foods can be systematically reduced while more internal, natural rewards take their place.

Motivational words

Motivating Children With Autism

Motivating children with autism is a multiple step process.

  1. Identify what your child enjoys on their own or is already intrinsically motivated to engage with or accomplish.
  2. Select rewards and positive reinforcements for your child to use as extrinsic motivation.
  3. Gradually, reduce the extrinsic rewards as you notice your child learning a positive habit or experiencing more positive feelings about accomplishing activities.
  4. Communicate with your child about the changes they are experiencing. Motivating children with autism gains momentum as your child feels supported and acknowledges their own positive progress.

Using extrinsic rewards is a common concern that others may have when considering an ABA therapy. However, professionals leading ABA programs plan ahead and strive to transition from extrinsic into more intrinsic forms of reinforcers over time. The use of transitional positive reinforcements, or extrinsic rewards, is an important factor in a child’s program that creates more positive associations with new behaviors.
If you are struggling to identify what motivates your autistic child or you would like to see changes in what motivates your child, it may be a good time to reach out to a trained professional. You can get help evaluating the influences of autism and motivation in your child. An ABA professional can also create a program tailored to your child to help them make progress towards motivational goals.

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

ABA-based therapy can be used in a multitude of areas. Currently, these interventions are used primarily with individuals living with ASD; however, their applications can be used with individuals living with pervasive developmental disorders as well as other disorders. For ASD, it can be used in effectively teaching specific skills that may not be in a child’s repertoire of skills to help him/her function better in their environment whether that be at home, school, or out in the community.  In conjunction with skill acquisition programs, ABA-based interventions can also be used in addressing behavioral excesses (e.g., tantrum behaviors, aggressive behaviors, self-injurious behaviors). Lastly, it can also be utilized in parent/caregiver training.

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

Agencies that provide ABA-based services in the home-setting are more likely to implement ABA services similarly than doing the same exact protocols or procedures. Regardless, an ABA agency under the guidance of a Board-Certified Behavior Analyst follows the same research-based theories to guide treatment that all other acceptable ABA agencies use.

ABA-based services start with a functional behavior assessment (FBA). In a nutshell, a FBA assesses why the behaviors may be happening in the first place. From there, the FBA will also determine the best way to address the difficulties using tactics that have been proven effective over time with a focus on behavioral replacement versus simple elimination of a problem behavior. The FBA will also have recommendations for other relevant skills/behaviors to be taught and parent skills that can be taught in a parent training format to name a few. From there, the intensity of the ABA-based services is determined, again, based on the clinical needs of your child. The completed FBA is then submitted to the funding source for approval.

One-on-one sessions between a behavior technician and your child will start once services are approved. The duration per session and the frequency of these sessions per week/month will all depend on how many hours your child’s ABA services have been approved for—usually, this will be the number recommended in the FBA. The sessions are used to teach identified skills/behaviors via effective teaching procedures. Another aspect of ABA-based services in the home-setting is parent training. Parent training can take many forms depending on what goals have been established during the FBA process. The number of hours dedicated for parent training is also variable and solely depends on the clinical need for it. If a 1:1 session is between a behavior technician and your child, a parent training session or appointment is between you and the case supervisor and with and without your child present, depending on the parent goal(s) identified. Parent training service’s goal is for you to be able to have ample skills/knowledge in order for you to become more effective in addressing behavioral difficulties as they occur outside of scheduled ABA sessions. Depending on the goals established, you may be required to participate in your child’s 1:1 sessions. These participations are a good way for you to practice what you have learned from the case supervisor while at the same time, having the behavior technician available to you to give you feedback as you practice on those new skills.

As mentioned in the beginning, no two ABA agencies will do the same exact thing when it comes to providing ABA services; however, good agencies will always base their practice on the same empirically-proven procedures.

How do I start ABA Therapy?

In most cases, the first item required to start ABA therapy is the individual’s autism spectrum disorder (ASD) diagnosis report. This is typically conducted by a doctor such as a psychiatrist, psychologist, or a developmental pediatrician. Most ABA therapy agencies and insurance companies will ask for a copy of this diagnosis report during the intake process as it is required to request an ABA assessment authorization from the individual’s medical insurance provider.

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

The next step to starting ABA therapy is to contact an ABA provider whom you are interested in working with. Depending on your geographic location, ABA agencies exist in many cities across the United States. Your insurance carrier, local support groups, and even a thorough online search can help you find reputable and properly credentialed ABA agencies near you. Our organization, LeafWing Center, is based in southern California and is recognized for aiding people with ASD achieve their goals with the research based on applied behavior analysis.

Once you have identified the ABA provider with whom you wish to work, they should help you facilitate the next steps. These will include facilitating paperwork and authorizations with your funding source. Once the assessment process begins, a BCBA (Board Certified Behavior Analyst) or qualified Program Supervisor should get in contact with you to arrange times in which interviews with parents/caregivers and observations of your loved one can be conducted. This will help in the process of gathering important clinical information so that with your collaboration, the most effective treatment plans and goals can be established for your loved one. This process is referred to as the Functional Behavior Assessment (FBA) and is elaborated on in different blog posts on our website. With regard as to what can be expected once ABA therapy begins, please read our blog post titled: When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?

How Do Attention and Learning Rates Play a Role in a Child’s ABA Program

Children with autism can be easily distracted and may require a high level of assistance in order to attend to tasks and activities. Their attention span is typically shorter than that of their typically developing peers. When this is the case, an ABA program will begin teaching concepts by breaking them down into simple teachable steps in a distraction free environment, such as in their bedroom or in a quiet room in the house. For example, it may be too difficult for a child with autism to learn to count from 1-10 all at one time. Therefore, each number in the sequence will be taught one by one, at the pace of your child’s learning (chaining). On Monday, they may learn the number ‘one,’ on Tuesday, if they still maintain the memory of the number “one,’ they will be taught the number ‘two,’ on Wednesday, if they still maintain the memory of numbers ‘one’ and ‘two,’ they will be taught ‘three,’ and so on. While this may seem like a very slow learning rate, a child will be taught at the rate they are capable of learning.

With shorter attention spans, it is also important to note that clear, concise, and simple instructions are typically more effective in producing effective learning opportunities. This is why simple and clear language is often used in ABA programs. For example, the instruction, “point to number 1” is a much clearer instruction than “can you please point to the piece of paper that has the number 1 written on it?” and therefore, more likely to produce the desired response. However, it is also important to note that with continued success, and as attention and learning rates increase, language and instructions should be modified to include more complexity. This will help to promote generalization.

Children with autism typically need to not only learn in small steps, but require much repetition until the skill comes easily to them. Therefore, in an ABA program, the learning environment is structured so that it will allow as much repetition as a child needs while maintaining their motivation  and interest in learning. When children begin ABA programs, they may need many repetitions on the concept before learning or mastering the concept. However, it is common to find that over time as a child learns “how to learn,” that these repetitions become fewer and fewer and learning rates increase. Some describe this phenomena as “learning to learn”.

When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?

The following are things that you should expect as a parent when you begin treatment for your child with Autism.

You and your child have a right to a therapeutic environment.  This means that the teaching environment set up to help your child is one in which socially significant learning occurs.  As a client, your child also has the right to services from an agency in which their number one goal is the personal welfare of your child (e.g., safety, treatment efficacy, advocacy). This means that all energy put into the program is to help your child become more independent and lead a better life.

It is also your child’s right to have a treatment program supervised by a competent behavior analyst. Unfortunately, as the rates of autism have increased, so have the number of treatment programs allegedly providing assistance to children with autism.  Furthermore, in many locations, the demand presently outweighs the supply for trained, experienced behavior analysts. It is imperative that the credentials and qualifications of your service provider be credible.

Your child has a right to be provided with a program that teaches functional skills. Functional skills are skills that a child can use in their everyday life and that furthers their independence (tying shoes, initiating conversation, engaging in cooperative play, etc.). There is little benefit in taking the time and dedication to teach a child something that cannot be incorporated or used in their everyday life.

Assessment and ongoing evaluation are crucial components of any ABA program, and should be expected.  This includes setting up a program based on the individual needs of a child and continuing a program based on the ongoing needs of a child. These needs will continually change, therefore ongoing assessments and modifications are imperative, necessary, and a right.

Parent and caregiver trainings should be included in the ABA program. These typically include meetings between parents or caregivers and their service provider in which valuable ABA strategies are discussed, demonstrated, and implemented. The focus of these meetings is to educate parents about various but individualized ABA based techniques they can implement with their child to address challenging behaviors, reinforce desirable behaviors, and promote generalization of progress.

Lastly, and perhaps most importantly, a child with autism has the right to the most effective treatment procedures available. In this case – scientifically validated treatment programs which today have only been shown to be based on ABA principles and techniques.

Motivating Children With Autism

Motivating Individuals Living with Autism: Intrinsic and Extrinsic Motivation

Motivation can be challenging issue for most of us. Take for example the fact that a lot of us struggle to exercise or to get on a diet even though these lifestyle changes could likely make a huge difference in our health and consequently, our quality of live.  In Behavior Analysis we sometimes discuss motivation by categorizing it in two ways—intrinsic and extrinsic. Looking at motivation in this way gives rise to an interesting conceptual discussion which points back to the work behavior analysts do with children with autism. Intrinsic motivation refers to motivation that would be described as coming from within a person. That is, you do something because you like it. For example, the prima ballerina that rehearses 8 hours a day because she wants to be able to perform exceptionally. Extrinsic motivation on the other hand refers to motivation that comes from others or our environment.  For example, some employees in a manufacturing company may show up to work on time to avoid getting in trouble with the boss (a quick footnote is that our behavior is under many influences and thus there are many sources of motivation on behavior at any given moment. These are rudimentary examples to help facilitate the point of motivation).

The same intrinsic and extrinsic motivational mechanisms apply with children living with autism. Many children with ASD are not interested in doing all of the things that we would like them to do or other tasks or skills that other typically developing children do.  Some of our children on the spectrum may choose to engage in repetitive play or ignore others. It is not uncommon for children with autism to attend to things that only they find interesting. And when this free time is interrupted or when they are asked to attend to something or someone else, they may appear unmotivated to learn or disinterested. In some cases, other challenging behaviors may be occasioned if we follow-through with our demands.

Without motivation, the learning process may be significantly slowed down if not impossible; therefore, at every stage of an ABA program, every effort is made to increase a child’s motivation to learn. Ample time is spent finding out what things a child likes (e.g., reinforcer surveying or reinforcer sampling) and what things will motivate them to attend long enough to learn.

Motivation in an intensive Applied Behavior Analysis program may initially take the form of something external (extrinsic), such as being rewarded with their favorite foods, candies, or activities. Often times, verbal praise and high-fives or anything that a child may find enjoyable is used. However, it is hoped that over time, this motivation will transition from extrinsic to intrinsic such that a child will engage in learning for personal joy and accomplishment (e.g., building a block house and being happy with the completed structure) and for that reason, rewards like candy or other foods can be systematically reduced while more natural rewards take their place.

Using extrinsic rewards is a common concern that others may have when their use is considered in an early ABA program. However, as long as individuals managing ABA programs plan ahead and strive to transition from extrinsic into more intrinsic forms of reinforcers over time, the use of extrinsic forms ought to be considered in their child’s program in order to facilitate learning early-on in the service.

Parenting Survival Skills

Do you ever feel like your child or children take all of your energy and you therefore have no energy to give to your spouse, partner, or friends?  This is very normal although so important to pay attention to, be mindful of, and work at.  Humans are social beings and we need that support network to function in our daily lives.  Without it, we will get worn down and we will eventually see turmoil in our relationships, work, and ways of parenting.  Below are some relationship recommendations that are so important when raising children, more importantly, children with autism.

First, ensure that you have a close adult companion who you can confide in.  If you have a spouse or partner, it will most likely be them.  If you do not have a spouse or a partner, identify a close friend who you can have real, open conversations with and who can call on when in times of need.  It’s important to let someone know what you are going through and how you feel.  Someone who just listens can be a great source of strength.

Second, have high levels of communication with your partner about your parenting strategies, away from your child.  It is so important to have consistent parenting styles and strategies.  Disagreeing during an episode with your child will only increase the stress and make matters worse.  The communication needs to happen when you are alone with each other and you can come to resolutions.  This will help in times when one parent needs a break and the other parent can step right in and be consistent with the strategies that the first parent was just using.  Just as a marriage builds a relationship, a child builds a team.

Ask for help, especially at first. Don’t hesitate to use whatever support is available for you. Your family and friends are there to help, but may not know how.  Maybe you can just have someone take the kids out for an afternoon? Or cook dinner for your family one night.

If you can, allow yourself to take a break, take some time away.  It can be as simple as taking a walk or even going to see a movie, going shopping or visiting a friend can make a world of a difference. Schedule fun adult time on a regular basis, away from your child, with your partner or close friends.  This is so important!  Parenting is difficult and brings many challenges to relationships.  It is important to spend time together, focusing on the two of you and not worrying about your child in the next room.

Lastly, don’t forget to rest.  If you are getting regular sleep, you will be better prepared to make good decisions, be more patient with your child and deal with the stress in your life.

Remember that if you want to take the best possible care of your child, you must first take the best possible care of yourself. Relax, have fun, and focus on you!

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How To Make Long Car Rides More Manageable With Children With Autism

Taking a long car ride anytime soon?  It’s time to start planning how to keep your child busy and how to make the long drive as enjoyable as it can be.  Some children with autism may do really well on car rides as it provides them with time for them to do enjoyable things such as looking out the window and watching the trees and other cars go by.  Some may enjoy listening to the music in the car, or even sleeping throughout the trip!  Other children may not do so well and parents may run into troubles such as crying, screaming, kicking seats, and even trying to get out of seat belts.  Regardless of how easy or how difficult your car rides are, some of the below strategies may assist with make the ride a bit more enjoyable.

First, remember to switch on the child lock so that the rear door cannot be opened from the inside. If your child is someone who tries to get out of the seat belt, then you may consider getting covers or locks for the buckles in the backseat. Also, make sure that the child’s car seat is installed correctly.  You can also make the car seat more comfortable for the long car ride by adding more padding under the seat cover.

Providing visuals can be another great strategy in making long road trips more manageable.  Use schedules, maps and even photo albums to help understand where you are going and whom you will see. Any type of visual support will reduce anxiety and increase interest.

Your child may need to take some regular breaks and be able to get out of the car to stretch or run around.  Look for signs that your child may be anxious, such body language, and take pit stops as needed.

Planning out the mileage of the trip and divide that mileage up into small chunks can be very helpful. If you are driving 300 miles, break this up into 10 chunks of 30 miles (or even 20 chunks of 5 miles, depending on how often your child may need positive rewards for good behavior).  Every 30 miles that your child behaves well (define this for your child such as sitting nicely, no screaming, and no kicking) he or she is allowed to pull a prize out of a prize bag that you have prepared ahead of time with treats, small toys, and special items that your child will enjoy.  Children with autism often dislike uncertainty and that uncertainty often creates overwhelm and behavior problems.  To avoid this, draw out squares on a piece of paper so he knows how many squares are left until you arrive at your destination.  Possibly make the half way point a very large prize, if he or she earns it.

Prepare a snack bag as well as a toy bag ahead of time so you have food when your child is hungry and toys when your child is bored.  Toys such as drawing boards, electronics (iPad or similar device) on which the child can play games or watch movies, travel games such as perfection, and books may work well to keep your child occupied.

The theme is to plan ahead so you and your family can be prepared for the long trek ahead.

Have fun and Bon Voyage!

What Kinds Of Behavior Are Behavior Analysts Interested In

Behavior analysts are interested in behaviors which are observable and measurable. Voluntary behavior, or what is known as Operant Behavior, is of particular interest to behavior analysts. This is the kind of behavior that we are primarily concerned with when it comes to helping children with autism as it is the type of behavior that can be influenced or learned as a consequence of environmental events. We can manipulate a person’s learning of operant or voluntary behaviors by manipulating environmental events. For example, parents often reward their children for cleaning up their room (an attempt to reinforce the behavior). Cleaning a room is a voluntary behavior and by rewarding such voluntary behavior, the parent has set up the environment to increase the likelihood that their child will clean up the room again to get rewarded again. For the purposes of this post, we will use the terms reward and reinforce interchangeably, though reinforce is the correct term.

The second type of behavior is involuntary behavior, or a reflex. Technically, it is referred to as a Respondent Behavior (as opposed to an operant behavior). Reflexes are automatic behaviors that are physiological and not usually influenced by consequences. You as a person have little or no control in the behavior occurring. This includes behaviors such as a sneeze, becoming startled when something jumps out at you, or blinking. Since reflexive behavior is automatic and cannot be changed by environmental events or consequences, this type of behavior is rarely the focus of an ABA program.

In general, behavior analyst have an interest in reducing maladaptive, undesirable, challenging behaviors while increasing desirable replacement behaviors. Replacement behaviors are alternative behaviors we would like to teach individuals to take the place of the challenging behaviors. These behaviors should serve the same purpose (function) of the challenging behavior, be socially appropriate, and easier to engage in than the challenging behavior.

Addressing Eating Issues With Children With Autism

Do you have troubles getting your child to eat meals, let alone healthy meals?  Many children with autism have difficulties with eating, either because of texture sensitivities, taste aversions, food allergies causing their diets to be very limited, or even just a lack of interest because they would rather be playing or doing something else.  Whatever the reason, it makes it stressful and difficult for parents to plan for and provide well balanced meals.  However, there are many strategies that are available to help parents through these tough times!

First, create an appropriate environment, structure eating times for the whole family so your child with autism begins to experience a routine, with everyone involved.  Designate a specific table where snacks and meals will be eaten. If challenging behaviors are typically high during eating times, designate one parent to focus on your child with autism so the other parent can focus on the other siblings, if applicable. This will also allow the adults and other siblings to be role models for the child with autism.  It is also important to remove distractions from the environment.  For example, have the tv and tablets turned off for at least 30 minutes prior to eating whenever possible.

Second, if your child does not normally sit for meal times but rather “grazes” snacking here and there, start with a very short requirement.  For example, allow your child to leave the table if he sits for three minutes, or eats a particular number of bites (see below). Increase the expectation for the time at the table as your child is successful. Using ‘first – then’ can be very powerful. First, eat 3 bites then you can go play!

Third, set clear rules.  Visual charts help really well to show children with autism when they can get what they want.  So, if they are playing with the iPad when it’s dinner time, take the iPad, ask them if they want the iPad, if they say “yes” then tell them “first sit for one, two, three minutes (pointing at drawn boxes on a piece of paper) and then you can have the iPad!”.  Or, “first eat one, two, three, four, five bites (pointing at drawn boxes on a piece of paper) and then you can have the iPad!”  Give a happy face, a sticker, or some other drawn symbol in each box when your child finishes a bite or a minute goes by.

Lastly, make eating fun!  Incorporate your child’s favorite character into eating (e.g., make pancakes in the shape of Mickey Mouse).  Allow your child to choose which plate she wants; even take her to the store and let her pick out which set of dishes she wants.  If your child likes music, play a small bit of music on the radio after she takes a bite.  Always maintain a positive tone, be calm, follow thru with the expectations that you have set and of course be creative, have fun, and don’t forget to smile and have fun yourself!

Some Components Of A Good ABA Program For Children With Autism

An effective ABA program should have the following components:

A Board Certified Behavior Analyst (BCBA) who designs and supervises the ABA program. A Board Certified Behavior Analyst (BCBA) is a person who has met the educational and professional training requirements established by the Behavior Analysis Certification Board (BACB). Many autism special interest groups also recommend that the supervising BCBA have experience working in the field.

A second common characteristic of an effective ABA program is a detailed and thorough assessment of the learner’s behavioral and clinical needs. Before an ABA treatment program begins, it is imperative to assess the clinical needs of a child to formulate treatment goals and a highly individualized curriculum. A Functional Behavior Assessment (FBA) typically includes direct observation of the client in their natural environments, interviews with parents and caregivers, record review, questionnaires, among other methods. In fact, assessment should not only occur before the onset of treatment but should be an ongoing process throughout treatment. This helps ensure that a child’s goals will remain individualized, and relevant to his or her needs at any given time.

From this detailed assessment comes the next common characteristic of an effective ABA program: meaningful and objectively defined skill development and behavioral goals. Goals in ABA typically fall under two general categories: Skill-development goals and behavioral goals.

  1. Skill-development goals are designed to address a child’s skill deficits and are based on their current needs, their developmental age, and their chronological age. A child’s developmental age is the age that represents their current abilities and adaptive levels, whether that be a year behind or two years behind their chronological age. Their chronological age is their actual age in years since they were born. Sometimes it is appropriate to teach a child skills that will match their developmental age. For example, when learning to speak, children will speak individual words before forming sentences. So, when teaching a child to speak, you begin at their developmental age for language and move forward from there. Other times, it makes more sense to teach a child skills according to their chronological age, as is the case much of the time when teaching toy play. You a teach a child to play with the same kinds of toys their friends play with so you can facilitate their friendships when they are around other children. Skill development goals should be highly individualized, socially valid, and address a child’s skill deficits across relevant domains (motor, academic, language, executive, play, adaptive, etc.) This is what is meant by meaningful goals, goals that are socially significant.
  2. Behavioral goals typically include reducing challenging, undesirable behaviors while simultaneously teaching desirable replacement behaviors. Identification of the function or “purpose” of the challenging behavior is an imperative first step in this process. An effective assessment will identify the function or functions of the challenging behavior(s). For example, after observation and data analysis, a BCBA may hypothesize that the function of a child’s tantrum behavior is “escape”. In other words, the hypothesis is that the child is engaging in tantrum behavior to escape or avoid a task, demand, or activity. From this point, a behavior intervention plan will be established to reduce the tantrum behavior and increase appropriate replacement behaviors such as asking for a break or requesting help. Replacement behaviors are alternative behaviors to the challenging behavior that should be functionally equivalent (serve the same purpose as the challenging behavior), socially appropriate, and easier to engage in. An effective behavior intervention plan should include proactive (before the challenging behavior occurs) and reactive (after the challenging behavior occurs) strategies.

Another part of goal setting in an ABA program is choosing objective goals. Objectively defined goals are important as it is a way of measuring an individual’s success and the appropriateness of how we are teaching an individual. When goals of the treatment program are defined in observable and quantifiable terms, a treatment program can make sure that a child is making progress towards the end goal. However, if the goal is vague, such as “teach social skills” rather than, “Billy will learn to initiate ball play games with his friends at school during recess time with 90% accuracy over a period of 4 consecutive weeks” it is difficult, or rather impossible to see if a child is making any progress. Therefore, goals have to be objective, observable, and quantifiable.

Measurement of the established goals is the next characteristic of an effective ABA program. Data collection and frequent review of progress are critical to effective ABA programs. When information on a child’s progress is collected while they are learning the task, their progress can be monitored to see if their learning rates are increasing, if their learning a new skill in an appropriate amount of time, or if progress is slow and the goal needs to be redefined or teaching techniques have to be altered. Without data collection, sound clinical decisions cannot be made.

Also, effective ABA programs will include numerous ABA techniques and principles into teaching a child to learn. ABA is more than just a discrete trial.

Further, an effective ABA program will promote independence across all areas of a child’s functioning. While initially a child may need help learning a new skill, once that skill is learned or ‘mastered’ a child will be expected to engage in that task all by themselves, or independently. The more independent a child becomes, the more they can navigate their surroundings without help.

The next two characteristics of an effective ABA program are that the program provides many learning opportunities for the child and that the intervention is consistent. When talking about learning opportunities it’s important to note that while a child is in an ABA therapy session, their mere presence alone is not enough to make sure that learning is occurring. It is up to the teacher to ensure that the child is absorbing the information provided and that the session is filled with such learning opportunities: in other words, ensure that the teaching session is productive. The goal is to get the most output or maximum learning in every session and to further the skill from where it was in the last session to a step closer in independence in the current session.

Consistency refers not only to  the number of treatment hours, but also to the notion that all team members are teaching a child using the same principles and techniques, and are working on the goals and instructions that were indicated to be effective when the assessment was undertaken or as directed by the leader of the team. So even though different people may work with a child across the span of a week, the child’s teaching will mimic that as if only one teacher was present the entire time.  For example, if teacher one is teaching a child the first step of brushing their teeth, which is to put the toothbrush in their mouth, teacher number two will continue where teacher number one finished, and teacher number three will continue where teacher number two left off.  This scenario actually shows one of the reasons why data collection is imperative. If the teachers did not take data on a child’s progress during their session, then the next teacher scheduled to work with a child would not be informed about what step to pick up from and/or which teaching techniques to use.

Another component of a good ABA program is the use of positive reinforcement.  While we will discuss positive reinforcement in more detail later in sessions, positive reinforcement basically means providing a reward for a behavior to increase the chances that the behavior will occur again. It is important that a child be in a positive learning environment, so that they are praised for their accomplishments and thus motivated to keep on learning. Children should be having fun during their sessions even though a lot is expected of them. Therefore, the use of positive reinforcement is essential.

Generalization is also a key component of an effective ABA program. Generalization refers to the concept that a child will demonstrate what they have learned in the ABA session outside of the ABA session; what they have learned to demonstrate with their ABA teacher with other people in their environment; and what they have learned to do using simple and concise language, to more complex language. Without generalization a child may only be
able to demonstrate a skill with a specific person, at a specific place, at a specific time. This is sometimes seen when a parent says, “oh he does it for me,” meaning that when a teacher asks a child to do something specific, say to clap, the child does not clap.  However, when the parent asks their child to ‘clap’ the child claps. This does not mean that a child does not know how to clap, it simply means that the child has not generalized clapping from his parents to another person. Generally speaking, it is more important for a child to do one thing with anyone and everyone asked, then a hundred things with only one person at one time and in one place.

Given this concept of generalization, good ABA programs will include parent training as a key part to the treatment program. Parents are key members of the ABA program and in a child’s life, they know their child best. As parents spend most waking hours with their child, it is important that they be educated and trained in continuing where the ABA session ended. An ABA therapy program is simply much more than the number of hours a professional agency works with a child – it should involve all environments in a child’s life. The principles of ABA should be incorporated into the child rearing practices in the families implementing this program so that there is consistency in a child’s environment and that as many learning opportunities during waking hours that can be captured, are in fact captured. That does not mean to say that parents become mini teachers outside of therapy and stop being parents, but it does mean that parents and other significant caregivers are an integral part of the treatment team.

Last but not least, an effective ABA program will hold regular meetings between all team members and the family to update a child’s curricula, targets, and goals, and will continually and consistently collaborate with other professionals working with a child in other domains.  This may include a child’s school teacher, speech therapist, medical doctor, psychiatrist, or anyone who has a say in helping a child. It is important that all members of a child’s team collaborate so that they are working together rather than unknowingly working in opposition to one another. And this is especially true when it comes to the area or domain of challenging behaviors. It is imperative for the welfare of a child that all persons interacting with a child are especially consistent in how they react when a child is engaging in an inappropriate behavior. So, by having consistent collaboration with other professionals on a child’s team, such consistency can be maintained.

Making Bedtime And Sleep An Easier Routine For Children With Autism and PDD

Bedtime can be one of those nightly events which many parents love or hate, or both!  It means that peace and quiet is soon ahead, but it also can mean that a huge struggle is about to proceed.  Many children with autism have difficulties either transitioning to bed, falling asleep, or even staying asleep all night long.  As all of these difficulties can increase the stress and tension in the home, below are some strategies to help reduce this potential stress. Keep in mind that no single suggestion will for all children and getting the right amount of sleep will allow your child to perform better academically, encourage the development of motor skills, and allow them to maintain a better mindset.  Not to mention, it’ll help mom and dad get a fuller night of rest, too!

Probably the most important strategy is to create a consistent nightly routine around the same time each night.  A routine helps signal the body that it’s time for bed and it can be soothing if there’s a lot of stimuli around. The routine can consist of a bath/shower, getting dressed for bed, playing a board game with the family, and/or reading a few books to quiet down.   Whatever the routine, keep it consistent so the child learns what to expect each night.

To enhance your child’s understanding of the nightly routine, you may consider using a visual schedule so they understand what happens in the evenings.  Take pictures of all events (e.g., dinner time at the table, bath time, reading books, and the child in bed), laminate the pictures and a piece of construction paper, and Velcro each picture either horizontally or vertically on the paper.  When each event is completed, you can guide your child to take off the picture and point to the next event.

If your child is one that seems wound up, even when he is physically in bed, make sure that the activities in the nightly routine are calmer in nature.  Choose books over exciting and loud family games.  Dim the lights when reading books. Play soothing instrumental music (baby lullaby bedtime music works well!) throughout the bedtime routine.  Focus on making sure the environment is quiet and calm.

If your child has a hard time falling asleep, or wakes up in the middle of the night, first consider if she takes naps during the day.  You may want to reduce these naps so your child is more tired at night time.  If your child wakes up in the middle of the night, be sure to keep the sleeping environment calm and do not allow him or her to play games or leave his or her room.  This may take many sleepless nights by the parents but it will pay off in the end.

Parents, remember, the time you invest in putting a sleep routine now will save you many, many hours in the long run and you won’t have to do it forever.  Once the patterns are established, you will be able to reclaim a large part of your evening for yourselves.