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Some children ‘just get it’ when it comes to toilet training. Others, not so much. Toilet training is a huge developmental milestone. It increases independence, helps social relationships and it can be a really important skill when thinking about school readiness. For those young ones who aren’t having success with conventional methods of toilet training ABA can help.
Let’s look at the example of “Johnny” (not his real name!). He’s been engaged in therapy for about a year, responds well to reinforcement, is making lots of gains in his program. However he’s about to go into Kindy and has been unsuccessful in his toilet training attempts with his parents so far. Johnny’s mum approaches her ABA Program Manager about this skill and they develop a program to toilet train him. Within three weeks he goes from zero toilet use to independent requests for the toilet for both wee’s and poo’s!
How did we toilet train?
There are a few key area’s that need to be addressed in toilet training. First, you need to be able to “catch a wee”. This then gives you the opportunity to reinforce weeing in the toilet. Second, you need to teach the sensation of a full bladder and teach this as a natural antecedent to Mand (request) the toilet. Third, fine motor skills for pulling up and down pants are important if the child’s toilet use is going to be independent.
In a typical toilet training intervention, we will work on all of these skills through a very intensive program. This will include taking the child to the toilet regularly and providing reinforcement, then thinning out the schedule and increasing teaching opportunities to request independently.
In summary, ABA can help toilet train almost anyone! This case reflects the success of a young child, but these methods can be implemented with a child of any age, both younger and older.
When thinking about toileting interventions, your practitioner will need to get medical clearance from your GP first. They will need to rule out any underlying medical problems that may be causing toileting problems. The next step is to meet the parents/carers and talk through strategies and to explain any risks and the realistic time commitments before you begin. An intensive intervention around toileting can be hard work…but very rewarding too!
Please feel free to contact Rachel Puan or myself should you want to know more about our toileting interventions on 9274 7062.
Program Manager ABACAS
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Many parents find getting their children to do homework challenging. For some children school = work and home = fun. Some children will question the fairness: “But mum, I’ve spent 6 and a half hours at school doing work. Why do I have to do school work at home too?” Others may feel that they simply have better things to do and resist your efforts. In these instances you may need to simply stand your ground, set good routines in place and practice patience!
For some children though other factors may be at play that impact on them being willing or able to do their homework. Just three to start with:
- The level of homework that is given to your child may be too difficult.
- Your child is physically and mentally tired after a long day at school.
- Your child is feeling stressed by homework and their own internal need for it to be “perfect”.
How then do we tackle such behaviours?
First and foremost, we have to determine the function of behaviour. In other words, why does the child not want to do their homework. Was the task too difficult? Does it have something to do with a skill deficit (e.g. the child simply can’t do it)?
Some of the things that we can look into include:
- Breaking down the work into small achievable steps (learning to deal with money require other skills such as coin recognition, addition and subtraction, coin value – more and less, etc.).
- Place small demands (10 minutes of homework before play time and increase expectation slowly).
- Have strong reinforcers in place (if the child sits down and does 10 minutes of homework for a week, he gets to pick a fun activity to do over the weekend).
- Communicate with the child’s teacher to see they are able to provide homework that is catered to their current level.
- Sit down and spend time with your child. Your attention may be more valuable than anything else.
For our some children the underlying issue may be straightforward. For others, it may be more complex hence the need to work through barriers.
For children in our ABACAS program, your program manager is there to help work through these issues with you. They can sit with you an objectively have a look at what is happening and work with you to put some steps in place to ease the transition back into a positive homework routine.
Assistant Program Manager
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I know you may not want to hear it be we are approaching the end of the school term and the long holidays. Many parents of children with autism often face this time with a range of emotions – relief and anxiety. Relief that there is an end in sight for the daily school & daycare routine. Anxiety when you think about how you will be keeping your child occupied over the holiday period.
Start planning for the holidays now (while you have the time and energy!)
Here are three ideas/strategies to help you cope with what’s to come:
- Create a visual holiday routine/schedule
For someone who struggles to differentiate between the days of the week, it is essential to establish a routine for a child with autism. By establishing a routine, you will be able to offer a sense of control and structure. It will also be much easier to transition to the back to school routine once the school term starts again next year too.
When a child is anxious about what is going to happen it will often come through in their behaviour. For example, I have seen children ask repeatedly for swimming throughout the day as they do not have an idea what they will be going next. Obviously, it’s a rare parent and child who is not going to be stressed by this behaviour (in the child’s case note being able to go swimming on demand). And yet, this behaviour may be avoidable.
With a visual schedule, children can see what is expected of them and what they can expect to do next. From a therapy perspective I would encourage you to think about including some time to practice the skills that they have mastered during therapy sessions too.
Your therapy team can help you work out how to create a visual schedule so please let them know if you’d like this help. Putting one in place now (even when it may not be as needed) is a nice way to transition into the holidays too.
- Let’s keep learning!
Learning does not end when the school term ends. When therapy stops (e.g. at the end of term) we often see a decline in skills acquisition and maintenance over the long holiday period. Being out of routine and not having therapy can lead to lots of stimming time and not enough skills practice.
Apart from keeping up with regular therapy sessions, I recommend my parents to spend time generalising the skills that their children have mastered within sessions. Holiday time can be spent expanding their skill sets and to exposing them to new stimuli. For example, teaching children to tact zoo animals when you make a visit to the local Perth Zoo or teaching them to tact car colours while playing “I spy” on the road.
- Have some down time
Being a parent is hard work. Therefore, it is very important to look after yourself during the holidays. Be it spending some alone time by the beach or even taking a short 5 minutes break to sit and sip on a hot cup of coffee before it gets cold. Do it. Because you deserve it. And remember, happy parents usually make for happy children too!
Holidays don’t have to be stressful!
In actual fact, holidays can be a lot of fun. Start thinking about how you will set up your days, particularly once you get past Christmas.
Please talk with your Program Managers about the activities that you could do to help generalise the skills that your child has learned during their therapy sessions. While the office will be shut from the 22nd December through to the 7th January, most of the team will be on board through-out the rest of January. We usually have a bit more flex during the holidays so increasing therapy sessions is also an option.
Assistant Program Manager (ABACAS)
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In the last post of this series, I want to talk about behaviour change and ABA. I spend a lot of time on this blog talking about ABA being more than just tackling problem behaviour. ABA build skills, provides early intervention, social training, and much more. However, tackling problem behaviour is something we do, and often do very well. Working with problem behaviours requires multiple steps, and commitment from a number of people.
What’s involved with behaviour change?
I’ve outlined some basic steps for effective intervention below:
Your Program Manager will want to establish a stable base-line before they intervene. This can tell us a number of things such as, is the behaviour naturally decreasing and maybe doesn’t need intervention? What situations does the behaviour occur in, and are we able to predict it accurately? What does the behaviour look like?
All behavioural interventions should be function based. Interventions which are function based are supported in the research to be the most effective. Evaluating this might require formal testing, or can sometimes be done through observations.
- Replacement Behaviours
How can this child get their needs met in other ways? People have a right to get their needs met, and others have a right to have theirs met too. The solution should involve not only reducing the problem behaviours, but increasing skills and tolerance of the reasonable preferences of others.
Once all this information is gathered, there needs to be a long term plan to fade any artificial systems that might need to be put in place to increase tolerance and skill building to a level that can be maintained by the natural environment.
Making sure everyone is on board
The initial phases are the easier part, once all this information is gathered and a plan is written, all the people involved in the child’s life will need to buy-in to the plan. This means that they commit to following the recommendations consistently, across the board, and increase to the next stage of the intervention only when criteria is met in all environments. This part of the process is just as important as the plan itself.
For more information about ABA and how we can help with challenging behaviours please talk to your Program Manager (Rachel or I). We will be able to work out with you the best way to help.
ABACAS Program Manager
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The collective gasp of all the people in the room is a familiar sound every time I mention the word “punishment”. I can thank some poor ethical choices from 50 years ago, and the confusion between the word punishment in regular language versus what it means in the context of Behaviour Analytic literature. This article will cover what reinforcement and punishment are in terms of behaviour, and hopefully you will have a better understanding of how we use these effective techniques, in a safe and ethical way.
Let’s start with reinforcement. Reinforcement is the addition or removal of a stimulus, that increases the future frequency of a behaviour. Any time behaviour is increasing (or maintaining) you are reinforcing it. You can reinforce your partner doing the dishes or them sitting on the couch, your child’s tantrums or their use of functional communication. There is no good or bad in reinforcement, it only refers to the behaviour increasing.
This is the same for punishment. Punishment is the addition or removal of a stimulus, that decreases future frequency of behaviour. Once again, there is no good or bad, and punishers are not necessarily things the average person would find aversive or see as harmful. Let’s look at some examples.
|Antecedent (before)||Behaviour||Consequence||Future Frequency|
|A parent says “please do your homework”||Child completes homework||Parent praises the child||Behaviour increases, more homework is completed (reinforcement)|
|A parent says “please do your homework”||Child completes homework||Parent praises the child||Behaviour decreases, less homework is completed
We may think we’re doing one thing…but actually children see it as another!
In this example the same sequences of events occur, and we see different effects on the child’s behaviour. It is these effects on behaviour that determine what is punishment or reinforcement. We see this happen in our daily lives all the time, we think that we’re helping, but behaviour isn’t changing or it’s getting worse. When we break it down something that we are doing in earnest, is actually punishment (reducing behaviour).
In conclusion, reinforcement and punishment are not about good and bad, they are scientific terms that help us understand behaviour. Once we understand a behaviour then we can change the environment, or up-skill people around us, to help a child better succeed and have a happier time in their home, school or community.
Please call Rachel or I on 9274 7062 for more information about your child’s program or about any of our services.
ABACAS Program Manager
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In the next of our five part series, we look at verbal behaviour in children. Some children come into our ABA program with little or no expressive language. Some of our young clients expect their parents to “read their mind” and just “know” what they want. In other cases, parents have developed really good skills of predicting or anticipating the child’s needs. For example, parents learn very quickly that when their child starts climbing up the bookshelf – it usually means that they want something.
For many of our young clients, the first step is to teach them the value of language. From a behavioural perspective, this may mean teaching the child the function behind a word. A child may be able to say the word “help”. However being able to say the word, is not the same as knowing that “help” is the word to use whenever the child requires assistance. For example, being able to use the word “help” becomes very handy when trying to reach that thing that’s out of reach.
Types of Verbal Behaviour
In order to understand this better, let’s have a look at the types of verbal behaviour. According to Skinner, verbal behaviour can be categorized into these parts: echoics, mands, tacts and intraverbals:
|Echoics||Repeating what is heard vocally or with the use of manual sign imitation – for example, saying “water” after another person says “water”.|
|Mands||Requesting for something – for example, asking for “water” because you are thirsty.|
|Tacts||Identifying objects, verbs, situations by labelling them – for example, saying “water” when you see water.
|Intraverbals||Answering questions – for example, saying “water” when another person asks: “What would you like to drink?”|
An Example of Teaching Verbal Behaviour
Programs focusing on verbal behaviour often start by working out what a child is able to do. There is no point trying to teach a child to use the word “water” if they are not yet able to produce the correct sounds. A child may first need to be taught how to say “water” and to learn how to pronounce it correctly so that others can understand (using echoic strategies).
From there, the next stage it to teach the child that saying the word “water” will lead to good things happening (in this case being given something to drink or to play with). This is the process of teaching mands. Positive reinforcement is important as it will lead to the child being more likely to say the word “water” whenever he/she wants a cup of water. A flow on effect from this is that in increasing the child’s vocabulary, we might be able to reduce problematic behaviour (e.g. sinks being flooded and fridge doors left open).
Of course, we also want the child to be able to use this new word in other contexts. For example, being able to apply it to new situations (e.g. looking at the ocean and commenting on the “water”) through to being able to answer other people’s questions (e.g. “what would you like to drink?”).
Where to from here?
All of our clients enter into our programs with different levels of language. The job of your ABACAS Program Manager is to understand their current level of skills and work out next steps.
Please feel free to talk to either of the Program Managers about any questions you may have about verbal behaviour and your child.
To find out more about our services in general please call the Child Wellbeing Centre on (08) 9274 7062.
Assistant Program Manager, ABACAS
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Three term contingency?? For parents who are new to ABA, you’ll be discovering that we use a lot of jargon. It is our job to make sure that we not only translate this into layman’s terms for you, but also educate you about ABA terminology throughout your therapy journey. This is going to be one of a 5 part series focused on educating parents about terminology, what they mean, and how you can start applying them yourself. Parents continuing the work we do into the home, especially during Early Intervention (EI) is essential to see optimum success.
5 Part Series
In our five part series we will be covering the following terms:
- The three term contingency
- Functions of behaviour
- Verbal Behaviour
- Reinforcement and Punishment
The Three Term Contingency
The three-term contingency is a critical part of ABA, and all behaviour can, one way or another, fit into this breakdown. ABC, or Antecedent – Behaviour – Consequence, is how we frame behaviours. Behaviour and learning doesn’t happen in a vacuum – there is never a behaviour with no explanation. An antecedent is what happens before, and a consequence is what happens after. An antecedent can signal that reinforcement or punishment is, or is not, available for certain behaviours.
Here are some examples:
|The teacher says “who knows what letter this is?”||Child responds by putting his hand up and saying “a”||Praise from the teacher (attention)|
|A child has a difficult homework task in front of him.||Child says “Can I help you with the dishes mum?”||Mum says “yes of course” and they do dishes together (escape and attention)|
|Therapist says “What goes woof”||Child responds “Car”||Praise and an edible are given (tangible and attention).|
|A parent asks a child to turn off the TV||The child has a tantrum||The child is allowed 5 more minutes (tangible, escape).|
The consequence that is provided determines whether or not learning will occur. In three of these examples some “unhelpful” learning is occurring!
Sometimes your therapy team might ask you to keep ABC data on a behaviour of interests so that we can help design an intervention based on function (more on that next week).
If you are interested in this topic, or have any questions further questions about how this might be applicable to your child please feel free to call me on 9274 7062.
ABACAS Program Manager
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Many parents who are first starting ABA as part of their child’s early intervention (or may have had some experience with ABA therapy) often ask the question, “will my child be sitting at the table the whole time?”. For Early Intervention (EI) clients, the answer should be no. Early Intervention ABA Therapy focuses on a combination of teaching developmentally appropriate skills and reducing challenging behaviours. How many small children do you know who spend 2+ hours a day seated at a small table with an adult? I imagine the answer is none.
ABA Therapy might teach children some skills at the table because this is a good way to ensure focus, reduce distractions and deliver the maximum number of learning opportunities. However, once these skills are mastered at the table then Natural Environment Training and generalisation should be used so these skills can consolidate. There is no point in children having ‘therapy skills’ and no practical skills.
What skills can be taught?
ABA can focus on improving play, social skills, daily living skills and toilet training. If these are socially significant goals for your family and your child, then ABA can teach these using the same principles of learning applied when teaching a child to discriminate between two flash cards. Social relationships, which is often one of the most difficult skills for children with an Autism Spectrum Diagnosis, should be taught in a way that will open up opportunities with peers, not just therapists and adults, and sets children up for success in real life situations.
Daily living skills (such as brushing teeth, washing, dressing etc) can all be taught using ABA in the natural environment. Your Program Manager should be able to develop a behaviour chain for any skill, and teach it to your child until they are able to function independently. The goal for any skill is that is provides benefit to the child, whether that be increased independence, increased access to learning, or increased access to relationships.
Early intervention ABA should use a range of strategies
It is important to have realistic expectations of children in a therapy context, including how much time is age appropriate to spend at a table. ABA programs should be comprehensive and focus on more than table top skills. They should be individualised and consider self care, social relationships and play as well as language development and verbal behaviour milestones. They should use a range of strategies to ensure that all that valuable learning can be used in different contexts.
If you have any questions about your child’s program please contact your Program Manager on 9274 7062.
ABACAS Program Manager
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Through this post we talk a lot about our evidence-based practice, what ABA is and how this therapy can help you. You might not realise this but parents have a huge role in therapy and are often pivotal in the progress that children make. Therapy requires commitment from all parties but the results are worth it. The evidence shows that parental involvement in early interventions can predict academic outcomes later down the track, and the amount of school support required.
Therapy is not something therapists ‘do’ to your child. Therapy is not a quick fix for problem behaviours. Neither is it a cure for anything (and we don’t want it to be). Therapy is a long term investment in skill development that sets your child and family up for the best quality of life possible. An important message to take away from this is that the skills that are being learnt are not just skills for your child. Therapy provides an opportunity for you as the parent to learn new skills. It’s about showing you different ways to respond to behaviour and also how you can foster your child’s development and honour behaviour support plans.
How Can I Engage with Behaviour Therapy?
Parents often start off feeling a bit lost when they start therapy. Should you ask lots of questions? Yes! Should you know your child’s goals? Yes! Should you feel comfortable with the techniques being used and do you have a right to say no? Absolutely. All therapy should be negotiated with you and you should be regularly updated by the therapist about the progress your child makes in therapy and any problems along the way. Your understanding of therapy will help to foster continued use of strategies in the home…and hence allow your child to make positive steps.
Therapists love parents asking lots of questions so if you’re feeling unsure about how to do something please ask us. Therapy skills need generalising with new people, in new environments all the time and parents are some of the best people to do this.
Work with your Behaviour Therapy Team
An ABA Team can consist of many people. In our program your main contacts are your 1:1 Behavioural Therapist and your Program Manager. Program Managers aren’t out as often as your regular therapist. It’s important that you can be open with your Program Manager and communicate frequently. Make sure you email or call if you have concerns and ask your regular therapist to CC you in on any updates. You can also take up parent training and consultation services. Aside from a nice way to meet other parents (training) it’s also a way we can empower parents and help to work through issues that are occurring outside of therapy.
As always please feel free to contact your program manager on 9274 7062 to discuss any concerns or to fin out more about programs.
Program Manager, ABACAS
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ABACAS Update – Our therapy model is evolving
ABA Programs should be individualised, socially significant and measurable. As a parent it’s hard to know what things to look for in a program, who can administer a program and how often services should be delivered. At ABACAS we are always working towards being in line with the Behaviour Analysts Certification Board. All our staff are Registered Behaviour Technicians (RBT’s), or training to be, and we are supervised appropriately by a Board Certified Behaviour Analyst (BCBA). As our program grows and changes, we aim to provide a model that is going to be the most effective and ethical.
The program is currently changing its service delivery model. We want to make sure that our parents have more contact with the Program and/or Assistant Program Manager and we want to provide more supervision for our therapists. We have introduced Program Evaluation Sessions (PES) into therapy schedules. A PES is where the program manager runs the therapy session with the child, thereby giving the program manager the opportunity to make sure that skills are generalising and that the program is working well. Our plan is to rune a PES every 6th hour of therapy provided, and a Program Review every 12th hour.
What are the benefits of this change?
Other than you and your child having more access to their Program Manager, and more supervision for therapists there are many benefits of working the program this way. These benefits are tied in with the 7 principles of ABA, which have been italicised for your reference. Generalisation will be addressed, to test whether your child has just learnt how to read one person, or if they are consolidating and generalising skills naturally. Programs will be more effective because they are more regularly evaluated, the data can be inspected more often and changes made quickly if a program needs new steps or is stagnating. This also ties into the program being technological, as more time will be spend producing programs that are highly individualised. We will be able to provide more applied interventions, which means working on programs that are meaningful to you, as your Program Managers will know you and your family better.
With increased supervision therapists will better understand the research base that programs are derived from, and are therefore more conceptually systematic. This makes delivery more analytic, in that the programs will be demonstrable in their effects on behaviour, and most important, programs should be behavioural. We focus on building new, measurable, socially significant skills, that are making a difference in your child’s life and future.
We’re very excited about these changes as we feel it will only enhance the therapy we provide for your child.
What do I need to do?
Your program manager will discuss what these changes will mean with you at your next review. However feel free to talk to the team in the meantime should you have any questions.