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Autism and bedtime routine

Design a bedtime routine that can be a win-win situation for your autistic child and yourself. Bedtime can be one of those nightly events which many parents love or hate or both! It means that peace and quiet are 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. Any of these difficulties can increase stress and tension in your home. Keep in mind that no single suggestion will be for all children but 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 you get a fuller night of rest, too!


a child sleeping

Bedtime routine for children with autism

The first step to a healthy sleep starts with the daily routine. Be consistent. By creating a visual schedule, it helps to remind your child what they should be doing and what is to come. 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 which helps them to actively check off their tasks.

Praise your child for successfully completing steps in their bedtime routine. Descriptive praise is when you tell your child exactly what it is that you like. For example, ‘I like the way you’ve found a spot for everything in your room’. This helps your child understand exactly what it is that they’ve done well. It’s also more genuine than non-specific praise like ‘You’re a good boy’. For younger children, you could use a reward chart.

A typical daily routine for better sleep

It is important for the daily routine to be consistent with time and order. Make sure your child wakes up every morning at the same time. They eat breakfast at the same time. Whatever the routine, keep it consistent so the child learns what to expect. A routine helps signal the body.

Morning routine

  • Wake up at 7 am
  • Brush teeth
  • Take a shower
  • Get dressed
  • Brush hair
  • Make bed
  • Eat breakfast

Afternoon routine

  • Eat lunch at 12 pm
  • Exercise for 1 hour
  • Plan activity

Evening routine

  • Eat dinner at 6 pm
  • Watch TV
  • Play a board game with the family
  • Read a few books to quiet down

Bedtime routine

  • Put on pajamas
  • Brush teeth
  • Go to the bathroom
  • Dim the lights
  • Put on the white noise machine
  • Give a massage
  • Go to bed

Remember there are triggers that might enhance alertness during bedtime like caffeine. Caffeine can stay active in our body for up to 12 hours. Monitor caffeine intake as well sugar consumption in foods. Watching TV, videos, or playing on the computer, especially if the shows or games are scary or violent, can lead to kids with autism having more trouble sleeping.

Problems sleeping happen more often in autistic children who have restricted and repetitive behaviors (lining up toys, rocking, hand-flapping), anxiety, or sensory problems and can lead to having trouble paying attention, feeling restless, getting angry, and throwing tantrums.


girl-sleeping

Autism and the successful bedtime routine

It can’t be stressed enough, to stick to a routine. Make bedtime routine no more than 20 to 30 minutes. The bedtime routine should be calming like reading a book, singing a song, or a massage. You know your child best. What is calming for one child may be stimulating for another. Design an area that encourages sleep. Make sure to only use your child’s bed for sleep. Keep the temperature in the room less than 75 degrees Fahrenheit. Don’t leave lamps or overhead lights on overnight. Nightlights can be used to provide some light. Using a white noise machine will help your child from being disturbed by noise around them.

If your child has a hard time falling asleep, or wakes up in the middle of the night, first consider if they take 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 their room. This may take many sleepless nights by the parents but it will pay off in the end. It is important that your child learn the skill of falling asleep without a parent present. All children and adults wake briefly during the night but quickly put themselves back to sleep by reestablishing associations used at bedtime. So if your child needs a parent present to fall asleep at bedtime, he might need a parent to help him fall back asleep during the normal awakenings.

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

Autism and bedtime routines: other considerations

It is important to address medical or psychiatric issues that potentially interfere with sleep. Your child’s medications might need adjustment if they affect his sleep. If your child suffers from a sleep disorder such as sleep apnea, sleep walking, sleep terrors, restless legs syndrome, they may need a referral to a sleep specialist. Some children with persistent insomnia will need further behavioral or pharmacological treatment to improve their sleep.

Children and Adults with autism tend to have signs of insomnia: It takes them an average of 11-15 minutes longer than most people to fall asleep. Many wake up frequently during the night. Some adults and children with autism have sleep apnea as well, a condition that could potentially cause them to stop breathing several times during the night.

Let Leafwing Center help with the daily routine for your autistic child, so you can have a successful bedtime routine. Our ABA therapists are trained in creating personalized plans that match your child’s ability levels.

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 bedtime routine

Design a bedtime routine that can be a win-win situation for your autistic child and yourself. Bedtime can be one of those nightly events which many parents love or hate or both! It means that peace and quiet are 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. Any of these difficulties can increase stress and tension in your home. Keep in mind that no single suggestion will be for all children but 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 you get a fuller night of rest, too!


a child sleeping

Bedtime routine for children with autism

The first step to a healthy sleep starts with the daily routine. Be consistent. By creating a visual schedule, it helps to remind your child what they should be doing and what is to come. 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 which helps them to actively check off their tasks.

Praise your child for successfully completing steps in their bedtime routine. Descriptive praise is when you tell your child exactly what it is that you like. For example, ‘I like the way you’ve found a spot for everything in your room’. This helps your child understand exactly what it is that they’ve done well. It’s also more genuine than non-specific praise like ‘You’re a good boy’. For younger children, you could use a reward chart.

A typical daily routine for better sleep

It is important for the daily routine to be consistent with time and order. Make sure your child wakes up every morning at the same time. They eat breakfast at the same time. Whatever the routine, keep it consistent so the child learns what to expect. A routine helps signal the body.

Morning routine

  • Wake up at 7 am
  • Brush teeth
  • Take a shower
  • Get dressed
  • Brush hair
  • Make bed
  • Eat breakfast

Afternoon routine

  • Eat lunch at 12 pm
  • Exercise for 1 hour
  • Plan activity

Evening routine

  • Eat dinner at 6 pm
  • Watch TV
  • Play a board game with the family
  • Read a few books to quiet down

Bedtime routine

  • Put on pajamas
  • Brush teeth
  • Go to the bathroom
  • Dim the lights
  • Put on the white noise machine
  • Give a massage
  • Go to bed

Remember there are triggers that might enhance alertness during bedtime like caffeine. Caffeine can stay active in our body for up to 12 hours. Monitor caffeine intake as well sugar consumption in foods. Watching TV, videos, or playing on the computer, especially if the shows or games are scary or violent, can lead to kids with autism having more trouble sleeping.

Problems sleeping happen more often in autistic children who have restricted and repetitive behaviors (lining up toys, rocking, hand-flapping), anxiety, or sensory problems and can lead to having trouble paying attention, feeling restless, getting angry, and throwing tantrums.


girl-sleeping

Autism and the successful bedtime routine

It can’t be stressed enough, to stick to a routine. Make bedtime routine no more than 20 to 30 minutes. The bedtime routine should be calming like reading a book, singing a song, or a massage. You know your child best. What is calming for one child may be stimulating for another. Design an area that encourages sleep. Make sure to only use your child’s bed for sleep. Keep the temperature in the room less than 75 degrees Fahrenheit. Don’t leave lamps or overhead lights on overnight. Nightlights can be used to provide some light. Using a white noise machine will help your child from being disturbed by noise around them.

If your child has a hard time falling asleep, or wakes up in the middle of the night, first consider if they take 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 their room. This may take many sleepless nights by the parents but it will pay off in the end. It is important that your child learn the skill of falling asleep without a parent present. All children and adults wake briefly during the night but quickly put themselves back to sleep by reestablishing associations used at bedtime. So if your child needs a parent present to fall asleep at bedtime, he might need a parent to help him fall back asleep during the normal awakenings.

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

Autism and bedtime routines: other considerations

It is important to address medical or psychiatric issues that potentially interfere with sleep. Your child’s medications might need adjustment if they affect his sleep. If your child suffers from a sleep disorder such as sleep apnea, sleep walking, sleep terrors, restless legs syndrome, they may need a referral to a sleep specialist. Some children with persistent insomnia will need further behavioral or pharmacological treatment to improve their sleep.

Children and Adults with autism tend to have signs of insomnia: It takes them an average of 11-15 minutes longer than most people to fall asleep. Many wake up frequently during the night. Some adults and children with autism have sleep apnea as well, a condition that could potentially cause them to stop breathing several times during the night.

Let Leafwing Center help with the daily routine for your autistic child, so you can have a successful bedtime routine. Our ABA therapists are trained in creating personalized plans that match your child’s ability levels.

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?

Observational Learning and Children with Autism

One of the main obstacles to learning that many children with autism face is a lack of observational learning skills. What is observational learning? It is learning that occurs without explicit teaching and by observing another person do something and simply doing what they do. Children with autism have difficulty learning by watching someone else and absorbing that information incidentally. For example, a typically developing child may look across the classroom and watch another child building a house using blocks. The next day at school this child may then build his or her own house using blocks without specifically being taught this task. This child simply watched another child, observed what the child was doing, was able to retain this information in his or her memory, and then accessed this information the next day in order to build a house. On the other hand, parents of typically developing children sometimes complain that their children are learning bad habits at school. This can also be observational learning at work. A child with autism may lack these imitation skills and so when they are in an environment filled with peers from which to learn, often times very little learning takes place. Opportunities for observational learning occur throughout the day and may contribute to a considerable amount of what we learn. Just think, was everything that you know explicitly taught to you? Chances are you answered “no”.

In an ABA program, one of the first skills taught to a child with autism is the skill of attending and imitating. Initially, this imitation might be as simple as imitating a handclap, or a wave. Over time, these imitation skills will expand so that the child can imitate complex behaviors such as how to watch a child from afar and build what they are building, how to play T-ball, how to draw pictures, or how to engage in self-care tasks such as brushing their teeth simply by watching, absorbing, and imitating. Imitation is one of the basic foundational skills needed for any child to be a successful learner. Therefore, there is much emphasis placed on imitation in ABA programs, particularly in the beginning stages of programs.

Why Do Some ABA programs Use Basic Language When Working with Children with Autism?

We know many children with autism typically have difficulty understanding language. These difficulties can be subtle. For example, a child may have difficulty understanding humor. In other cases, they may be more pronounced. That is, a child may respond to little or no language that is spoken to him or her. Taking this fact into account, most ABA programs will teach a child using simple and concise language at the beginning stages of the program. For example, if the goal is to teach a child to imitate a ‘clap’ the teacher would simply say, “Do this” or “Copy me” while demonstrating the action. The instruction would be limited to as few words as possible (in this example, two words and then a demonstration of the action). The teacher would refrain from using a longer instruction that contains more words such as, “okay, now I’m going to do something and I want you to watch me and then copy me after I’m done. Are you ready?” For a child who has difficulty understanding language, this instruction is laden with words that are unnecessary to complete the instruction and probably will include many words that the child does not presently know. Another example of this can be seen with one-word instructions given to children when attempting to teach them to perform actions. With this type of program, an instruction to the child may include something like “clap” or “stand up” and the child would perform the action. The general idea is here is to use fewer, and simpler words to evoke the desired response from the child.

Therefore, in the initial stages of an ABA program, the more concise and simpler the instruction, the more successful the child will be. It is important to note that the simplicity or complexity of language used should be based on the child’s language repertoire at the time of assessment. Over time, and with success, simple and concise instructions will be elaborated and more language will be incorporated into the instruction.

Increasing Language for Children with Autism

Impairment in communication is one of the main diagnostic criteria for a child with autism, specifically a delay in or total lack of spoken language.  Behavior analysts break down “language” into many reasons a child would communicate.  Based on these reasons, they identify where there are deficits and how they can increase these deficit areas.  We will outline some of them here in a very easy-to-understand manner and then give some advice on how to increase these forms of language every day.

The first form of language a child engages in is repeating.  This happens when a child repeats what another person says.  You may be thinking at this point that your child with autism does this a lot!  Many children with autism engage in this behavior although it is repetitive in nature and they do not do it to get attention from others (why typically developing children repeat language); they do it because it is fun for them. In order to learn other forms of language (which we will discuss below), a child should be able to repeat what an adult says on command. If your child does not do this regularly, give many opportunities for repetition, each day throughout the day.  Get your child’s full attention, say a simple sound or word very clearly to them (e.g., “ahhhh”) and continue to do this until they repeat or approximate what you are saying.  Provide lots of praise and even preferred items.

Another important form of language a child engages in is requesting.  Many children with autism engage in challenging behaviors as a form of requesting (e.g., crying to get a cookie and this results in them getting a cookie so they will quiet down), instead of using appropriate language (e.g., “mommy, can I have a cookie?”).  This form of language can be taught throughout the day, every day, if you know what your child wants.  Keep many of their preferred items out of reach, especially food items.  Whenever they show a desire for something, model what they should say or do to communicate (e.g., you say “cookie”, engage in the manual sign for cookie, or point to the cookie icon or picture for them to give you) and require them to engage in the same communicative behavior that you modeled before you give them the cookie.  Give them small pieces of food items, little sips of drinks, or a short amount of time to play with preferred toys so you can remove the item and practice requesting for the item again.  If you do this about three times each time they want varied things throughout the day, your child will begin to gain this requesting skill, and you may see a decrease in challenging behaviors.

Remember, to learn language your child must receive lots and lots of learning opportunities per day.  You can provide this by engaging in simple strategies such as the ones we discussed above.

What challenges have you faced? Please write us back and we will respond.

How to Teach Children with Autism How to Play Independently

Do you ever wonder how you make it through each day, getting your child dressed and to school?  What about shopping, laundry, house cleaning, and dinner? Somehow you do it, and that is enough for anyone to be proud of.  We want to provide you with some additional techniques that may help with the time when your child with autism is home and needs to be looked after, but you also have things to accomplish.

Preparing dinner is a great scenario that many parents have difficulties with.  The solution for many parents is to put a movie on, give the child the iPad, or to allow the child to engage in whatever self-stimulatory behaviors they enjoy most (e.g., running around the house repeating phrases, flapping objects up and down, or rolling cars back and forth on the floor while lying down staring at them).  Although these may be activities that make your child happy and allow you to get dinner ready, there are additional techniques that foster appropriate independent engagement by your child with autism during times you cannot provide your full attention.

Activity schedules work wonders for this purpose. Activity schedules are visual guides that lead a person through a series of activities, leading to an ultimate prize.  Visual schedules help with transitioning from one activity to another with minimal prompting.

There are some pre-requisites to being able to utilize schedules although these can be worked on in the meantime if your child does not have them.  Your child should be able to independently play with some objects, even if the object is as simple as a peg board, or as complex as a 100-piece Lego structure.  Laminate pictures of these activities and velcro them to a vertical strip hanging on the wall.  At the bottom should be a picture of what your child really wants to do in the moment, even if it’s dinner!  If your child has never had experience with an activity schedule, guide them through the process of pointing to the first picture, finding the activity, playing with the activity, putting the activity away, taking that picture off the schedule, pointing to the next picture, and so on and so forth until the ultimate activity or item is achieved.

Some tips: start with only one or two activities until your child can independently utilize the schedule and transition from activity to activity.  Also, remember that the activities should be somewhat preferred by your child, as this is their independent time and we want to increase the success of them playing independently.  If they dislike activities, this increases the chance of challenging behaviors and the need for more of your attention.  It may take a few days, or even weeks to develop this skill. Over time, your child will be able to complete this task with increasing independence, practice decision making and pursue the activities that interest him or her and it will give you some much needed time to get things done while at the same time knowing that your child is being productive.

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!

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.

Parent Tips To Determining Why Behavior Problems Happen

A helpful way to effectively tackle a child’s problem behavior is to figure out why it is happening in the first place.  To implement an intervention without this important information may produce no results or even make the challenging behavior far worse than it was before implementing the tactic you’ve chosen.

To figure out a behavior’s possible function, first we have to look at the antecedent—whatever it is that happened right before the behavior. And secondly, we also have to pay attention to the consequence that happens while or after the behavior happened.  This relationship between antecedent àbehavior ß consequence over time may contribute to why a child does the problem behavior.

There are four likely reason “why” a behavior may happen: for access, to escape/avoid, for attention, and for self-stimulation.

  1. Access

A problem behavior can be strengthened or reinforced when it produces a consequence that increases the chance of the problem behavior from happening again over time.

Example

A child is told he cannot have his tablet to play video games on which results in the child engaging in tantrum behaviors.  The parent does not want to deal with the tantrums so the child is given the tablet.  In this example, tantrums after being told “NO, you can’t have ____” resulted in the child getting what he cannot have.

A B C
Told no tablet/video games Tantrums Got tablet video games

 

  1. Escape/Avoidance

A problem behavior can be strengthened or reinforced when it produces a removal of something a person does not like (Escape).  The same strengthening of the behavior may also happen if the behavior prevents something that a person does not like from happening at all (Avoidance). Providing the behavior with either consequence may strengthen the behavior over time.

Example 1 (Escape)

A child is asked by his parent if there is homework for the day.  The child says yes and with her parent, starts working on the homework.  As the work becomes more difficult, the child starts complaining to the parent.  The parent instructs the child to continue working, but the child just continues complaining and eventually starts throwing pencils towards the wall. Unsure about what to do, the parent takes the homework off the table and tells the child that she doesn’t need to work on it anymore.

A B C
Instruction to continue with school-work Continual complaints, throwing pencil at wall School-work removed

 

Example 2 (Avoidance)

Upon getting home, the parent asks the child if there is homework for the day.  The child replies, “No homework today, yay!”  There is homework for that day.

A B C
Parent asks about homework Lies about having no homework Homework avoided
  1. Attention

A problem behavior can be strengthened or reinforced when it produces any response from another person that leads to the likelihood on the problem behavior from happening again over time.

Example

A family is having dinner at the table.  The elder child starts playing with her food and manages to flick a pea from her plate across the table with her fork.  The younger child starts laughing at his sibling being funny.  The elder child then repeats the behavior which makes the younger child laugh hysterically.  The parent asks the elder child to stop, but to no avail—peas scattered all over the dining table.

A B C
Other people at the table Flicking pea across the table (elder child) Younger child laughing

 

  1. Self-stimulatory

A problem behavior can also be reinforced automatically by the pleasant sensations the action produces. Parents can have an idea if a problem behavior may function for self-stimulation if the child performs the behavior regardless whether the child is around individuals or—and most especially—if the child is all alone.

Example

A child watching a video on her tablet “rewinds” the video to a specific scene, watches the clip for a few seconds, then rewinds the video once again to watch the same scene.  This chain of behaviors may repeat for an indefinite length of time.

A B C
End of favorite clip (and “desire” to watch again Rewinds video to the beginning of favorite scene Watching favorite scene again

Although there are now many tools that we can use to figure out the specific function of a behavior, parents and caregivers can still use A-B-C data analysis to help them find out the function(s) of a problem behavior to help determine the best tactic to use in addressing the behavioral difficulty.   For complex or intense problem behaviors that can pose a hazard to a child’s and others’ safety, it is highly advised that parents/caregiver seek assistance from a qualified behavior analyst.

autism puzzle

Why do you teach action labels to individuals with autism?

Because this program teaches the individual to engage in and identify common everyday actions/activities and can be used to facilitate the individual’s ‘commenting’ on other’s activities. It may be helpful to take pictures of the individual and family members or other important people in their life engaging in discrete actions and use these pictures to begin teaching the program. Once the individual has learned some actions, be sure to generalize this learning objective.