Clinical Corner: Our Priorities

We’ve talked about our theme of being the best provider of services for children with autism. This year we’ve been working across our locations on multiple projects to continue to enhance our skills.

Some of the key highlights include training our teams to use the world around them to teach in an even more playful and naturalistic way, focusing on social reinforcement as our primary goal to teach new behavior, and taking a closer look at our system of measurement to ensure efficient progress.

As we look ahead to the next few months, we have several exciting and challenging projects that we’re actively working on. Here’s a quick sneak peek at our clinical priorities list:

  • Enhancing our consultant training
  • Continued development of key clinical processes:
    • BIP’s (Behavior Intervention Plans)
    • Program Binder Organization
    • Data Rules
    • Error Analysis
    • Case reviews
    • Mand flow data sheets
    • Implementation of Precision teaching & Fluency based instruction training
    • Development of Electronic Training Platforms (Lessonly)

A clinical team comprising Liz Lefebre MA BCBA, Laura Grant MA BCBA, Danielle Pelz M.Ed BCBA, Chrissy Barosky MA BCBA, and myself is leading the development and implementation of these projects.

Finally, we’ve made great strides this year as a team. I am incredibly proud of our team and the great effort that gets put in every day. Let’s continue to raise the bar and expand the scope of what’s possible with our kids.

 

– Courtney, President Clinical Development

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May is Better Hearing and Speech Month

May is Better Hearing and Speech Month, a time to raise awareness about communication disorders and the Speech-Language Pathologists and Audiologists who provide treatment.

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A Speech-Language Pathologist (a.k.a. Speech Therapist) is a professional who evaluates and treats children and adults with speech and language delays or disorders. On the hearing side of things, an Audiologist is a person who provides diagnosis and rehabilitation of hearing loss.

I have worked as a pediatric Speech-Language Pathologist (SLP) for nearly 12 years now. I learned a lot in school to help me with my profession, but my real education has come from everyday experiences in working with children and their families. These invaluable experiences have molded me into the therapist I am today. One important topic comes up frequently when talking to parents: most wish they had more knowledge and awareness of speech/language development so they knew sooner that their child’s development was delayed.

The two main areas of communication development are Language and Speech. Language is the rule-based system that we use to communicate, including what words mean, how they can be put together, and how to make new words. It is made up of Expressive Language (what is said) and Receptive Language (what is understood). Speech is the actual verbal communication and includes fluency, voice, and articulation. SLPs also work on Pragmatics, the social use of language, and aural rehabilitation, after children receive hearing aids or cochlear implants. The American Speech-Language Hearing Association (ASHA) has fantastic resources on speech/language development that can be accessed here: http://www.asha.org/public/speech/development/chart/.

There is little information on the incidence of communication disorders and delays in the United States. In the 2005-2006 school year, 1.1 million students were classified in schools as having a “speech and language impairment”. This number is certainly higher to account for children who receive therapy in outpatient clinics, non-public schools, and in the home. Beyond these numbers are the numbers of children diagnosed with Autism. It is now estimated that 1 in 68 children are on the Autism Spectrum. 1 in 68. What this means for SLPs is that our caseloads are being made up more and more of children who have a diagnosis of Autism. Not all children with autism have speech/language challenges, many need help learning to follow directions, take turns talking, greeting others, saying words, signing, and imitating gestures and actions. The list goes on and on. A lack of or delay in communication is often the first sign parents have that something is going on with their child’s development and so it is so important to understand typical development.

All of that is the technical information about what I do. It is very important that parents, families, and the public understand what speech and language is and when to recognize a delay or disorder. But, I can tell you that there is so much more to what we do. This is a job that my fellow SLPS and myself are extremely passionate about. We LOVE helping children learn to communicate! There is nothing more rewarding than the first time a child says a sound, word, or their first sentence. THAT is why we do what we do every day.

Kristin Kouka, MA, CCC-SLP

Speech-Language Pathologist

Kouka Kids Speech Therapy, LLC

Little victories are so much sweeter.

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This is a guest post written by a former employee (whom we miss very much!) Amy Sartin is a BCBA living and working in California and offers these valuable insights for Autism Awareness Month.

“April is Autism Awareness Month! After close to a decade working with children with autism and other developmental disorders, here are my thoughts:

Autism can happen to anyone, anytime. Autism is not a reflection of poor parenting, or lack of education. Autism knows no race, ethnicity, culture, religious, or monetary bounds. I have seen the very strongest parents face the most unimaginable challenges with their children. One thing is for sure – raising a child with autism is not for the weak.

Often the media reports the negative side of autism – and let’s be clear – children and families with autism have to overcome so many obstacles, every single day. For a child with autism, something as simple as putting on clothes or eating breakfast can be difficult.

But here’s the thing – autism is not all darkness and doom. After working with hundreds of children on the spectrum, I have learned to appreciate the small things. Little victories are so much sweeter. Seeing something as simple as watching happy kids playing at recess or giving their dad a hug can bring tears to my eyes. Watching a child with autism communicate for the first time – whether it is vocally or through other means – will NEVER get old. Nothing makes me smile quite like a visit from a former client. Every single child I have ever gotten the opportunity to work with will always have a special place in my heart. There is nothing better than seeing a child master a skill that they have been working on for several days, weeks, or even months. I will never cease to be amazed by the kids I get to see every day.

Working in this field is not easy – but whether you are a teacher, a therapist, a consultant, or even just a nanny for someone with special needs – we HAVE to keep this perspective. We cannot become jaded. Take a moment to appreciate the amazing things we get to see every single day. Thank a parent who has entrusted you with their most precious gift – their child.

To those who are not affected by autism – take a moment to appreciate the little things. Smile at a child you see in the grocery store. Give your child an extra hug. Most of all, always keep things in perspective.”

Handling the Holidays: preparing your child with Autism for the holiday season

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Decorating:

• Decorate in stages, rather than changing everything at once. While holiday decorations are fun and festive, to a kiddo with autism the changes to a household can be sensory overload.

• Allow your child to interact with the decorations and help put them in place. Flashing lights or musical decorations can disturb some children. To see how your child will respond, experience these items in a store or someone else’s home first

Shopping:

• Last minute holiday shopping can be stressful for children who rely on routines.

• If you do take your child shopping, allow enough time to gradually adapt to the intense holiday stimuli that stores exhibit this time of year.

• Keep your receipts and make sure ‘surprise’ items are returnable.

Family Routines:

• Meet as a family to discuss how to minimize disruptions to established routines and how to support positive behavior when disruptions are inevitable.

• Continue using behavior support strategies during the holidays. Try social stories to help your child cope with changes in routine, and visual supports to help prepare for more complicated days.

• Make sure to take two cars to family events, so that if your child is too uncomfortable you can leave early.

• If you want to go to a grown up party, schedule help or babysitters in advance and familiarize your kiddos with them.

• If you are travelling for the holidays, make sure to have their favorite food, books or toys available. Use social stories to explain what will happen if travel involves boarding an airplane or overnight stays in new places.

Gifts:

• If you put gifts under the Christmas tree, prepare well ahead of time by teaching that gifts are not to be opened without the family there. Give your child a wrapped box and a reward for keeping it intact.

• Wait until just before the holiday to set out gifts, especially large tempting ones.

• When opening gifts as a family, try passing around an ornament to signal whose turn it is to open the next gift. This helps alleviate disorganization and the frustration of waiting. Also, if you have no intention of getting a specific item, be direct and specific about what they will and won’t receive. This will diffuse future meltdowns.

Play Time

• Prepare siblings and young relatives to share their new gifts with others.

• If necessary, consider giving your child a quiet space to play with his/her own gifts, away from the temptation of grabbing at other children’s toys.

And Remember!

• Brace yourself for melt-downs. Handle them as calmly as possible. Know your loved one with autism and exactly how much noise and new activity they can tolerate.

• If necessary, consider giving your child a quiet space to play with his/her own gifts, away from the temptation of grabbing at other children’s toys.

• Keep in mind what the holiday really means for you and your family– thankfulness & togetherness!

Here is the info as a shareable PDF:

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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

7 tips to help kids with Autism prepare for Fireworks

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The Fourth of July is a day that often involves, fireworks, barbecues and, at least around here, lots of crowds. For families that have children with autism, everything about the holiday can be a recipe for a meltdown. These seven tips were compiled for families that would like to see the show together. The key is to know your child’s limits and have an escape plan in case he or she needs a break.

Prepare for the Show 

Letting your child know in advance what might happen in advance will give your child some sense of control and help reduce his level of anxiety. Talk about exactly what you will be doing: getting in the car, taking a picnic, eating, watching fireworks, walking back to the car, waiting in traffic and any other details you can think of. The more your child knows what to expect, the better he will be able to handle the situation.

Preview the Show

Sparklers may not have much sound, but they look like mini fireworks. You can also watch videos of fireworks displays online. Fireworks Blast-Off  is an app ($.99) that lets the user control the colors and size of fireworks on the screen. Programs like this are great at simulating actual sound but not at the intense level you would find at a real fireworks display but they can serve as a good introduction.

Watch from far away

Your best option may be a nearby parking lot, or the side of the road with the windows rolled up may provide a comfortable and safe distance for your kiddo to experience the show.

Have a solid Plan B

When you make the decision to try a live fireworks display, be prepared to leave if your child becomes overwhelmed. Despite the fact that you have spent time preparing your child and have a pair of headphones available, things may not work out as planned. Keep this in mind when parking the car so you can have an easy route out

Take comfort items

Be sure to pack items that help to calm your child, such as a weighted vest, blankets, snacks, iPad or fidget toy.

Create a Social Story

A social story may work to prepare your kiddo for any event that might be stressful throughout the evening. A great social story is up for free download here.

Headphones

If you haven’t already, invest in a good pair of noise canceling headphones or construction grade earplugs. You may be able to prepare your child for the crowds and change of surroundings, but they may be over stimulated by the noise! You can even play soothing or patriotic music through them.

Indy with Kids has laid out Fireworks in the Indianapolis Area here.

Fort Wayne area Firework displays are listed here.

Greater Boston area Fireworks are listed here.

Have fun!

Gross motor activities to keep your kids active this summer

Gross motor activities for kids are incredibly important in the development of their gross motor skills. As school wraps up, you may find yourself with kiddos who have tremendous amounts of energy to burn this summer! These seven gross motor activities for autistic children  include activities that improve social skills while improving gross motor development. These skills are good for kids with autism but can easily be adapted to be fun for their siblings or peers!

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1. Jump on a Trampoline

Around here, the trampoline is a highly preferred activity for many of our kids with autism. Bouncing offers excellent sensory input that can be helpful in alleviating sensory overload. If you don’t have access to a trampoline at home, places like Flipzone in Plainfield and Skyzone in Fishers can be a fun day trip. If well supervised, jumping on a bed can also provide satisfaction!

2. Play Ball

Sometimes, simple activities that other kids can master easily might be very challenging for kids with autism. Catching the ball may not be realistic as a beginning step but you can work your way up that over time. Begin by rolling a ball back-and-forth with the kiddo. This simple task develops important eye tracking skills and it can encourage motor planning as the child follows the movement of the ball. Other activities include:

  • Kicking the ball
  • Learning to dribble
  • Bouncing on a ball
  • Tossing a ball into a net or target

3. Balancing

Balancing can also be very challenging for kids on the autism spectrum and many gross motor tasks require a sense of balance. Test to see if the kiddo can stand motionless with her eyes closed without losing balance to gauge how much work is necessary to develop balancing skills. You can start by using painter tape on the floor or a practice balance beam for them to follow. Balancing see-saws or playing hopscotch can also be fun for kids practicing this skill.

4. Bicycles and Tricycles

Riding bikes can help develop kiddos with balance as well as developing leg muscles. Bikes and trikes can be adapted to kiddos to make riding them easier. Indy Area Ambucs can answer questions or help find bikes appropriate for kiddos. Who doesn’t love biking on a summer afternoon? Don’t forget to outfit kids with protective helmets and other equipment 🙂

5. Pretend Play

Participating in pretend play is a considerable challenge for kiddos with autism. In some of these activities, kids can benefit from moving around while developing their imaginations. Ideas for pretend play that uses motor skills include:

  • Fly like an airplane
  • Hop like a bunny
  • Play restaurant at snack time
  • Do a crab walk
  • Do a frog jump
  • Slither like a snake
  • Gallop or trot like a horse

6. Dance

 Parents and therapists can use dancing with music to encourage imitation and it can be a great way to teach daily living skills. Dance ideas include:

  • Clean It Up
  • Freeze Dance
  • Head, Shoulders, Knees and Toes
  • Wiggle the Sillies Out
  • Hokey Pokey

7. Obstacle Course

In addition to improving gross motor skills, obstacle courses can be a great way to encourage kiddos to follow directions!  The course does not have to be complex to be effective. In fact, parents and therapists can begin with a course consisting of one step and gradually introduce other steps to the activity. Simple ideas for an obstacle course include:

  • Crab walk
  • Frog jump
  • Ball toss
  • Jump rope
  • Limbo bar
  • Walk a line or paint tape design
  • Climb over objects
  • Beanbag toss
  • Crawling through a tunnel or a cardboard box
  • Roll along mats or underneath obstacles obstacle_ladderrun1_l