Category Archives: Early Intervention

Is my ABA provider effective?

Applied Behavior Analysis (ABA) therapy for children with autism has been proven to work over a period of time. However, as a parent you may not have the necessary experience or background to determine if the level of expertise of a practitioner is meeting your child’s goals and needs.

Beyond the obvious signs of whether or not your child is making progress, there are some other factors when assessing a provider that you can use to evaluate their potential effectiveness.  Here’s a tool-kit that you can use.

Didactic Children Therapy

How many children are on your BCBA/ BCaBA’s caseload?  Of course, you might also want to check if the individual overseeing your child’s program is credentialed (Board Certified).  The best way to find out is to ask directly.  If that doesn’t work then you can approximate this by comparing the total number of children in the program with the total number of BCBAs/ BCaBAs.  There is no ‘correct’ number of children per BCBA/ BCaBA (it depends on the complexity of each program, the experience of the staff, number of assistants etc).  In our experience a good approximation is no more than 10.  You can also think about it this way – if your BCBA/ BCaBA has, for example, 15 kids, then assuming they spend about 2 hours a week with each child, that adds up to 30 hours (assuming no travel time from one location to another).  Now each child’s care also involves programming time (writing reports, collecting data training with staff etc).  Conservatively allocating around 1 hour per child for programming time totals 15 additional hours for a total of 45 hours. Add in usual administrative time for meetings, emails and other non-clinical weekly activities and very soon you’re above 50 hours/ week.  This is not an effective setting for providing quality of care and leads to compromises and shortcuts.

How many individuals are assigned to your child’s team? An effective model involves more than just the BCBA/ BCaBA overseeing a child’s program – such as such as trainers, program managers (or people assisting BCBA/ BCaBAs etc).  Additional team members should be assisting with some of the tasks mentioned above.

Is your child’s team trained?  How effective a provider’s training program is can have a direct correlation with how good your child’s program will be.  You should inquire about your provider’s training program and methodology to ensure adequate attention is devoted to this.

Is parent training offered?  For a child’s program to be successful – you should be able to ask for and receive training to implement some of the principles at home that are being used with your child everyday.

Is the child actually receiving one on one therapy? – Or are multiple children overseen by a therapist?  For ABA services to be most beneficial – your child should be one on one with a therapist.  Your child’s therapist should not be paired with multiple kids at once.  This is important not only for the quality of care – but also for how billing is done (if services are being accessed through health insurance)

Are you allowed free and open access to your child’s team and to his/ her sessions?  If not, that is a red flag… it is your child, after all and you should be able to observe your child’s sessions.  (Incidentally this is also a good way to check the above points about one on one therapy).

Are you able to interact with your child’s team on a regular basis and develop a good working relationship?  The level of communication and involvement that you have with your child’s team is a good measure of how vested the provider is in your child’s program.

What is the general vibe and environment like at the place of service?  Schedule a visit or request and observation. You can tell a lot by observing and interacting with the team.

Does your child’s staff take proper data and clinical note? You should be able to get a summary of your child’s sessions – either upon request or as a regular part of the process.  This is a good way for you to stay up to speed with your child’s progress.

Creative Children Therapy

Since time is your most valuable resource, especially when your child’s progress is concerned – it is crucial to have a toolkit to assess the effectiveness of your provider. These questions should serve as a starting point for you.

Further reading: http://www.bacb.com/Downloadfiles/ABA_Guidelines_for_ASD.pdf

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Tips for grocery shopping with your child with Autism

grocery

Hey parents!  I know grocery shopping with a child on the spectrum can be challenging at times.  Here are a few helpful tips that may help you get your get in and out of the grocery store successfully!

  1. Keep little hands busy from grabbing items outside of the cart by giving your child something to hold onto while in the cart.  It can be a little bag of snacks or a fun toy to play with.

 

  1. Make shopping a game.  Share the list of items with your child.  You can even make a visual list if it will be more helpful for your child to see the pictures of the items you need to find.

 

  1. Set rules and stick to them.  If you don’t follow through with the rules you set, your child will learn your rules don’t need to be followed.

 

  1. Reward good behavior and don’t reward the bad!  If your child is being cooperative, praise your child and deliver other desirable items and activities while you shop.  If your child makes it through the entire shopping trip successfully, reward your child afterwards such as go to the park or get some ice cream.

 

Start with short trips and work up to keep your child successful if shopping trips have a history of being very difficult.  You may need to start with going to the store to purchase only 1 item so that you can get in and out quickly to begin teaching your child how to behave while in the store so that you can get a chance to reward your child for being successful.  Once your child begins to understand how to behave in the store and learns that being cooperative leads to other desirable and fun things, you can gradually begin to increase the number of items on your list and the length of your shopping trip.

How to get your child to follow directions in 5 easy steps

Mother and daughter playing with ball in the park

Many parents of children with and without disabilities often struggle with getting get their child to listen to them or follow directions. Here are 5 simple steps we’ve compiled  to follow to help teach your child to listen and follow directions.

  1. Get close to your child before you start talking or giving a direction. It is suggested that you are less than 5 feet from your child before giving any directions. If your child can’t hear you or understand you, they can’t follow your directions!
  2. Gain eye contact with your child. This will get their attention and provide a good opening to give a direction. You may need to prompt eye contact by calling their name. For example, “Johnny, look at me” or use physical guidance to move their face toward yours. ALWAYS praise them for looking at you.
  3. Once you are close and have eye contact give a clear and concise direction.  When giving a direction make it a command or statement, do not make it a question. Instead of saying, “Can you get your backpack”, say, “Get your backpack”. At first it might be necessary to use only simple one-step directions in order to avoid confusion.
  4. Praise and reward your child for every direction that is followed and for all attempts to follow directions. If your child attempts to follow the directions but can’t quite get it done, praise them for trying and help them complete it. Praise and rewards should follow immediately. Avoid negative statements like “That’s not what I asked you to do” and “You aren’t listening to me” and ignore mistakes, remember at least they are trying.
  5. ALWAYS follow through. Make sure your child completes what you ask them to do even if physical guidance (i.e., hand over hand) is needed. In order to avoid empty threats or promises, only issue the directions if you are 100% committed to making sure that your child follows through. Don’t allow your child to avoid or escape directions placed upon them, as you want your child to learn that when you give them a direction the expectation is that it will be followed or you will help.

Remember learning should be fun. The more excited you are about it, the more excited your child will be to do it. You can also make a game of learning to follow directions. Hide a quarter (or something the child likes) somewhere in a room. Tell the child that he may have the item if he will listen to your directions and follow them exactly. Remember give the directions only once and if they find the item they get to keep it.

 

– guest blogger, Chrissy Barosky, MA BCBA

Manager of Clinical Development, Bierman ABA Autism Centers 

Planning Ahead: Tips for Increasing Your Child’s Success when Dining out in a Restaurant

We know that sometimes as parents it can be very difficult to take a child with autism to a restaurant with you. You might be worried that people may judge you if your child misbehaves. Below are some tips on how to plan ahead before going out to help keep your child successful and your trip enjoyable!

dining

1.) Find places that are designated as autism friendly; that may not have as many people and are not as brightly lit or as loud.

2.) Keep your child with you at all times, this will make them feel safe knowing that you’re by them.

3.) Set the expectations ahead of time as to where you’re going and what they can or cannot do while you’re there.

4.) Let your child have a say in what you do, you can even show them pictures so they can help decide where you’re going.

5.) Use the bathroom before leaving the house so your child is comfortable.

6.) Bring an item for your child to play with that they enjoy while you wait for your food – this could be an iPad, sensory items, toys or even a snack.

7.) Look at the menu beforehand, make sure there is a food option for your child that they will eat.

8.) Make a reservation or call ahead so you don’t have to wait to be seated upon arrival.

9.) Ask for a seat in a quieter, less crowded section of the restaurant, this can be less over-stimulating for your child.

10.) Don’t be afraid to ask the server for help – if your child needs a lid for their cup, or a snack to come out quickly.

11.) Request the check as soon as your food arrives.  This way, you will not have to wait long after your child is done eating.

12.) When your child behaves desirably reinforce good behavior with a snack or preferred item to play with.  Make good behavior worthwhile so they will want to behave well in the future.

13.) Have your child keep a preferred item with them so they will be less likely to be upset if they cannot have something they want.

Post by Holli Novinger, BCaBA, Manager of our Indianapolis Area Locations

Brain Development in children with autism: Importance of Early Intervention

In a study, it was suggested an MRI may aid in the early diagnosis of autism, thus stressing the importance of early intervention.

The study found children with autism show a faster development of grey matter in the brain (often in an 18 month span) compared to typical children in which the process often takes many years.  This rapid growth in such a short period of time may be too fast for the brain to handle and cause the brain to fail to make many neural connections.   Because of this, the infant may struggle when interpreting his or her environment and instead withdraw from the world.  Not until growth rate of the brain begins to slow down will the child begin to possibly use the useful neural connections and no longer use the connections that are not.

However, often by this time, the brain’s neural plasticity has already begun to decrease (causing the brain’s neural pathways to harden) making it even more difficult at this point for the brain to form new connections.

autism awareness series on autism treatment

April Autism Awareness month blog series

The argument for Early Intervention

If you notice your child is not meeting important developmental milestones, seek help immediately.  Don’t wait and hope “they’ll grow out of it”.  Small children are “sponges”.  Their brains have greater neural plasticity; allowing them to learn quickly. However, this plasticity begins to decrease with age.  This doesn’t mean older children are unable to learn, but that with age, learning patterns are formed, making it more difficult to change behavior due to a longer history of reinforcement.

Research shows that children who receive intensive early intervention services are likely to make more progress and have better long-term outcomes.  In fact, the long-term benefits of early intervention can decrease the costs of lifetime care by over two-thirds.

In addition, some children who participate in early and intensive ABA for several years acquire sufficient skills in order to transition into regular classrooms with little or no additional support.

Please refer to our website for more information: http://www.biermanaba.com/

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What does an early intervention program look like?

Early intervention programs can range from 25-40 hours per week depending on the child’s need.  If the goal of an intensive and early intervention program is to close the gap between the child and typically developing peers, programs can range from 30-40 hours per week.  Early intervention programs can increase language skills, play skills, social skills, academic skills, self-help skills and help to reduce problem behavior.  Programs should be very “play based” and fun for the child.

Because each child is different, the specific curriculum for an intensive intervention program can very dramatically according to each child’s specific skill strengths and deficits.  For example, one student could be working on things such as fine motor or gross motor imitation as well as developing a communication system through the use of vocals, ASL signs, or PECS and being taught through discrete trial format.  Another student could be working on social skills or group responding skills to prepare the child for the classroom environment through more incidental teaching techniques and teaching in the natural environment.  While each child’s curriculum and the way skills are taught may be different, it all still falls under the umbrella of Applied Behavior Analysis. mom-and-toddler-playing-with-blocks