A Deeper Look at ABA

Applied Behavior Analysis (ABA) has evolved in to one of the most effective therapies for Autism and Autism Spectrum Disorders. It is a therapy based in science and results. Children with autism that receive the recommended amount of ABA hours per week show a substantial improvement in behavior and learning. Simply put, the goal of ABA is to increase positive behaviors and decrease behaviors that negatively impact learning and daily life. This article will take a deeper look at ABA, and how it works.

Evidence-Based

ABA is an evidence-based best practice treatment of Autism. That means it has been scientifically proven through many valid and reliable experiments to work. This is a very important point. There should be a certain level of confidence associated with the treatments of any condition or illness. In fact, when intensive ABA is provided (between 25-40 hours per week), substantial gains are shown to be made. This has been presented in many studies targeting ABA.

How it works

Behavior Analysts go through a tremendous amount of training to be able to successfully provide the service. For the sake of this article, how ABA works will be simplified. The main goal of ABA as stated above is to increase positive behaviors and reduce negative ones. One of the main strategies behavior therapists use is positive reinforcement. Positive reinforcement is providing a reward for when a positive behavior has been used. After repetition and time, the behavior should be changed permanently. The reward is appropriate and applies well to the person receiving it.

Behavior analysts and therapists heavily focus on the cause of a certain behavior (Antecedent), what behavior was exhibited, and the consequence of the behavior. The consequence is a direct result of the behavior and may positive or negative. Using this method allows analysts to build programs tailored for individuals that are unique in what they are targeting.

Other helpful tidbits

ABA is provided by Board Certified Behavior Analysts (BCBA) and Registered Behavior Technicians (RBT), also referred to as Behavior Therapists. The BCBA’s evaluate the child, build the programming for the child, and then supervise the RBT as the program is implemented. All the data shows that the more hours of ABA a child gets, the more optimal results will be seen. An ABA team may consist of one BCBA and several RBT’s. The important thing is that the programs are followed closely, monitored for success, and adjusted for improvement. Most insurance companies do cover ABA services at this point, though, that wasn’t always the case. Benefits should be verified by the ABA company prior to therapy starting. This is a standard practice. Embarking on an ABA journey is a huge step in the development of any child with autism. Like anything else, the unknown may be scary. Having some information about it in advance can make all the difference in the world.

The Unique Benefits of In-Home ABA

Have you ever wondered about in-home ABA?

Keep reading to learn why we love this option for kids with autism.

A few years ago our Regional Clinical Director, Valerie Jaramillo, BCBA, was working with one of our kiddos. He was a young child who struggled with communication.  His parents were deeply concerned about his ability in the future to advocate for his own needs. They worried how he would answer questions, make friends, and have relationships. How would he tell people what he needed? How would his behaviors reflect the frustration that came from his delay in communication? It wasn’t that he didn’t understand what he wanted. Instead, it was an issue of how to communicate in the way the adults and peers around him understood. 
 
The family had tried an ABA program once before for a short time but hadn’t yet found the right fit. Valerie created a team for him in his home and started the process of creating programs. The long-term goal was to teach him how to communicate in a much more effective way. His ABA program was designed specifically to meet his needs. First, his therapists worked to use visual prompts to teach him responses to simple questions and greetings. When his communication skills started to grow, so did his treatment programs. His team included the community in his programming to allow for natural environment training, NET for short. Sessions started to fade out of the home and move into the community. They would walk to the corner store and practice making purchasing decisions. Then they practiced how to pay for it. The child and his team also enjoyed daily trips to local parks to meet with family friends and other peers. Step by step, therapists facilitated as this young child practiced his new skills. He learned to make friends and play with others. He worked hard, extremely hard, and his therapists supported him the entire way.
 
Each child is different and what they work on varies. Valerie explains that there are certain moments that emphasize just how beneficial in-home ABA programs are. It is one thing to practice a skill in a therapy room. It’s entirely different to join in the activities right there when the skill is needed. For example, when a child is approached at the park by a new peer, his therapists can help him practice his communication skills. Sometimes, they can even support the development of a new friendship. At Key Autism Services, our teams have witnessed hundreds of inspirational moments like this as our kiddos grow up in front of our eyes.
 
After experiencing stories that showed us how incredible in-home ABA is, we put together a list of benefits. There are many different services for kids with have autism. Each child is different so the variety of programs is exactly what we need. The benefits below are some of the reasons we love in-home ABA.
 

The unique benefits of in-home ABA: 

 

A familiar environment

 
It isn’t uncommon for our kids to go through a period of resistance when they start a new program. Conducting therapy in a familiar environment reduces the time it takes to adjust. Home-based ABA eliminates the need for the child to spend time adapting to a new an unfamiliar environment. New environments are often scary or take added time to get used to.
 

Eliminate a transition

 
Transitions can be a challenge for many of the children we work with. In fact, transitions themselves are often a goal we are working on during ABA Programs. Home-based ABA eliminates any need for getting ready to leave the home, transportation, or entering a new facility. This means we can spend the entire time practicing skills instead of overcoming resistance to attend each session
 

Home-Based ABA Saves time

 
Home-based ABA saves time for the entire family! Parents aren’t tasked with the extra errand of drop off and pick up from yet another appointment. Instead, they have ongoing support throughout the day incorporated into their typical routing. We save valuable time to spend productively with the therapy team versus in the car.

A Comfortable Environment for the Child

 
When ABA is done in the home, the child has a chance build rapport with new team members in a comfortable and safe space. They can focus just on a new team member and not have to factor in outside variables. It can be both distracting and scary to adapt to new children and unfamiliar spaces. With a therapeutic team in the home, the first step is meeting the therapists and building a strong relationship with them. Then, they can begin working to bring their new skills into other environments, on step at a time.
 

Reinforcers – Using each child’s favorite toy and activity. 

 
Reinforcers are a key part of behavior analysis. But the best reinforcers are the ones that motivate the child by using what they already love to do. These toys and activities are usually already in the home. Therapy teams can use the access to these reinforcers to spark motivation.
 

Naturalistic teaching

 
Conducting therapy in the child’s natural environment will allow for practice of skills directly related to family concerns.
 
For example, many of the kiddos in Key Autism Service’s home-based ABA programs are working on interactions with siblings. Therapy teams can work on this directly in their natural setting. They create programs that are structured around real interactions. Together, they can practice and improve communication with siblings. It doesn’t end with siblings, ABA can address any relationship or daily response.
 
Another common example is setting boundaries around electronics. At home, it isn’t unusual for a child to prefer to spend time on their iPad, video game, or other electronics. The behavior stops them from engaging with family or doing their homework. ABA teams wan work with the child to set limits with these items. ABA therapists motivate kids and teens to mange their time.
 

Generalization

 
Conducting therapy in the child’s natural environment will help to teach skills where the child needs them every day. When teaching how to brush teeth in a bathroom it may surprise you how important the bathroom setup itself can be. Imagine learning to find the toothpaste in drawers to your right then going home to find that they’re always in cabinets above you! Children may also need to learn how to use their specific appliances. Teaching these skills at home in the space and with the items that they will actually use can speed this up.
 

Parental involvement

 
Conducting therapy in the home promotes parental and family involvement. Parents are encouraged to sit in or observe sessions when possible. Many family members want to learn the goals and programs their child is working on. They can then incorporate what is learned to better assist with their child’s programming when the therapy team is not there
 

Sibling involvement

 
ABA therapy allows the incorporation of siblings into the therapy session. Time can be used to educate siblings, work on social skills, build a positive sibling relationship etc.
 

Involvement of other family members

 
Home-based ABA therapy can incorporate other relatives or caregivers present in the home. Can train nannies, grandparents, etc so that the whole team is on the same page with a consistent treatment plan.

Tips for Helping Your Child wear a Mask in the Community

Due to the current health pandemic that has been created by Covid-19, the Center for Disease control recommends “that you wear masks in public settings around people who don’t live in your household and when you can’t stay 6 feet away from others. Masks help stop the spread of COVID-19 to others.” This guideline can be challenging for all children, especially those on the autism spectrum and those with sensory sensitivities. The skill of learning how to wear a mask is especially important for children as it’s a necessary precaution for them to return to school. In person learning helps generalization of skills. It promotes children learning in their natural environment and it supports social opportunities outside of the home. 

Although challenging, these rules do not discriminate due sensitivities or diagnoses, so compliance is required in order to participate with others at stores, restaurants, parks, social gatherings and travel.  This fact has been highlighted recently in the news by airlines prohibiting children with autism from traveling if they are not wearing a mask.  Attempting to force children, especially those on the spectrum, to wear a mask is likely to cause a drastic increase in anxiety and challenging behavior.  This method also has the potential to create an aversion to masks, making it less likely that they will be able to learn to wear a mask in the future. 

Teaching your child to wear a mask when outside the home, may seem like an impossible task, but there are strategies that can be used to desensitize sensitivities and encourage mask wearing.  Before implementing these approaches, understand that this is a process and may take some time, so be patient with your child and make sure that if your child begins to reject the mask, you may need to take a step back. 

A few ideas to get you set up for success: 

  • Choose a mask that your child is likely to be drawn to. Whether the mask is the child’s favorite color, has a character that your child likes, or you decorate a mask together, allowing them to choose what mask is theirs will help them want to engage with it.  Due to the necessity of masks in recent months, they can be found in many stores and online vendors, and can fit around the ears, back of the head or around the neck and be pulled up (gator masks).  You may need to try a few different types before you find the perfect fit for your child.  Cloth masks will need to be washed and disposable masks will need to be replaced frequently, so it may be necessary to buy multiple masks when being worn regularly. 
  • Set up a reward system to reinforce your child for participating.  Depending on what is more appropriate for you child, you may need small rewards that can be delivered frequently after each step like treats or stickers, or tokens that can be earned to get a big reward at the end like when using a reward chart or token board. 
  • Create opportunities for the child to put a mask on you and/or a special toy.   As you go through this process, allow your child to see you and/or their favorite stuffed animal wearing a mask as well and let them practice putting the mask on you and the toy.  You can use phrases like “Teddy needs to wear a mask too, let’s put one on him.” 

After you have selected your child’s mask(s), have appropriate reinforcers and have a toy to practice with, you are ready to start the process. Depending on your child’s level of aversion towards wearing a mask, you may be able to skip some of these steps or move to the next step quickly.  Alternately, some may need to be worked on for longer, so feel free to try to move forward, but if the child struggles with the next step, then it may be necessary to go back to the previous step for a longer period of time. 

  1. Begin by having the mask in the environment where the child is, so that they get accustomed to having it near them.  Move the mask closer to them and begin to talk about it, show them how you put it on yourself and/or on their toy.  
  2. Have your child touch the mask with their hands, then touch it to their face, and eventually put the mask on.  This step could be done at one time, or over hours or days, as you may need to give your child time in between each trial.  You may be able to skip some of these or need to add in more “feeling” the mask opportunities.  Remember that if at any point during this step the child has an aversive reaction, that next opportunity you will go back to the previous step. After each part of this step, immediately remove the mask and provide a reward, as this is not to get them to actually wear it, but to experiment with how it feels. 
  3. Once the child can tolerate putting on the mask and having it immediately removed, you will begin to extend the time that they wear it.  This can be done by counting seconds together, setting a timer, wearing the mask into another room or area, doing a preferred activity during this time, or allowing the child to play with a preferred item while wearing their mask.  You will do this step multiple times a day, until you child can tolerate wearing the mask for whatever specified amount of time that you choose.  Be sure to reinforce after each trial. 
  4. After your child is wearing the mask for the time of your choosing with no aversion, then it is time to begin to experiment with wearing it outside the home.  Initially, choose a familiar place, that the child enjoys going to and that is easy to get in and out of in a short amount of time.  Some suggestions for this would be going into a frozen yogurt store, convenient store, grocery store or walking into a restaurant to get a pickup order.  After the child gets accustomed to these short trips and is able to wear the mask with no problems, then begin to extend the time of the trips out of the house. 

Once your child is consistently wearing a mask in the community, they should remain comfortable with it.  If your child infrequently goes out in public wearing a mask, you may need to practice at home to retain the skill.  It is hard to know how long masks will remain a fixture in our lives, but helping your child learn to wear one, will help to protect them and others and allow them to participate in everyday life. 

5 Signs of Autism in Babies

Early detection and intervention for babies who are on the Autism Spectrum:

 

Early detection of autism characteristics is crucial in your child’s journey to treatment. Although a new diagnosis or suspicion of autism may be an emotional challenge, it is very important to the child’s growth and development. Early detection and diagnosis can open many opportunities for treatment, support, and early intervention.

 What is Autism? What are the early signs to watch for?

Autism is a spectrum disorder under the category of developmental delay. A spectrum disorder is characterized by a number of symptoms that may or may not be present with varying severity. Symptoms of autism may include impaired social skills ( poor eye contact, lack of affection, lack of empathy, disinterest in peers or toys etc.) , impaired communication abilities (repetitive speech, impaired vocal communication etc.), and be accompanied by repetitive behavior (fixation on various topics or interests, rocking, hand flapping, toe walking etc.).

5 signs or symptoms of Autism in babies:

  1. Minimal response to sounds and familiar voices is another common characteristic. You may notice your child does not flinch or seem to register loud noises in the environment, he or she may not respond to your voice when you call or speak to them.
  2. Lack of gestural communication to get attentions such as holding arms out, pointing, waving, or shaking head.
  3. Your child may not make vocalizations such as cooing, babbling, or other baby talk. Many parents begin to feel concerned when they notice that their child is not speaking or attempting to make vocal sounds during infancy.
  4. Disinterest in acts of affection such as cuddles, hugs, or other forms of touch. Many children with autism are sensory sensitive and may not like to be touched, other children simply lack interest in these social practices.
  5. Delayed imitation typically relating to “watch and learn” behaviors from parents, siblings, or other children.

Delayed milestones and early warning signs does not guarantee an Autism diagnosis:

Although your child may demonstrate delays in similar area’s listed above, a single symptom may not mean autism. Autism is diagnosed based on a collective number of symptoms causing impairment of functioning. Your diagnostician will provide testing to rule out other potential medical or cognitive possibilities or confirm an autism diagnosis.

What should parents do if they detect any of these red flags?

If you have concerns about your child’s development it is important to discuss this with your pediatrician. Your child’s doctor may not detect these signs during a short routine visit and it is important to notify them of any concerns you have.

Although autism can seem like a scary thing the most important thing to remember is to advocate for your child’s needs. Early detection can allow early intensive therapies to minimize the symptoms and teach your child the skills they need to grow and learn.

Are you a parent of a child with Autism?

Learn more about Key Autism Services.

Our ABA therapists travel to your home to provide unique treatment plans for kids and teens with autism.

We work with Anthem Blue Cross Blue Shield, Aetna, United Health Care, Optum, Cigna, and more! Reach out to confirm your benefit.

A Comfortable Environment for the Child

 
When ABA is done in the home, the child has a chance build rapport with new team members in a comfortable and safe space. They can focus just on a new team member and not have to factor in outside variables. It can be both distracting and scary to adapt to new children and unfamiliar spaces. With a therapeutic team in the home, the first step is meeting the therapists and building a strong relationship with them. Then, they can begin working to bring their new skills into other environments, on step at a time.
 

Reinforcers – Using each child’s favorite toy and activity. 

 
Reinforcers are a key part of behavior analysis. But the best reinforcers are the ones that motivate the child by using what they already love to do. These toys and activities are usually already in the home. Therapy teams can use the access to these reinforcers to spark motivation.
 

Naturalistic teaching

 
Conducting therapy in the child’s natural environment will allow for practice of skills directly related to family concerns.
 
For example, many of the kiddos in Key Autism Service’s home-based ABA programs are working on interactions with siblings. Therapy teams can work on this directly in their natural setting. They create programs that are structured around real interactions. Together, they can practice and improve communication with siblings. It doesn’t end with siblings, ABA can address any relationship or daily response.
 
Another common example is setting boundaries around electronics. At home, it isn’t unusual for a child to prefer to spend time on their iPad, video game, or other electronics. The behavior stops them from engaging with family or doing their homework. ABA teams wan work with the child to set limits with these items. ABA therapists motivate kids and teens to mange their time.
 

Generalization

 
Conducting therapy in the child’s natural environment will help to teach skills where the child needs them every day. When teaching how to brush teeth in a bathroom it may surprise you how important the bathroom setup itself can be. Imagine learning to find the toothpaste in drawers to your right then going home to find that they’re always in cabinets above you! Children may also need to learn how to use their specific appliances. Teaching these skills at home in the space and with the items that they will actually use can speed this up.
 

Parental involvement

 
Conducting therapy in the home promotes parental and family involvement. Parents are encouraged to sit in or observe sessions when possible. Many family members want to learn the goals and programs their child is working on. They can then incorporate what is learned to better assist with their child’s programming when the therapy team is not there
 

Sibling involvement

 
ABA therapy allows the incorporation of siblings into the therapy session. Time can be used to educate siblings, work on social skills, build a positive sibling relationship etc.
 

Involvement of other family members

 
Home-based ABA therapy can incorporate other relatives or caregivers present in the home. Can train nannies, grandparents, etc so that the whole team is on the same page with a consistent treatment plan.

Helping Children Cope with Changes as a Result of COVID-19

Families across the country are adjusting to the many changes resulting from COVID-19, including changes in daily life, the way we educate our children, and what we will now define as the new normal. This also includes keeping children occupied and focused on what is important. It is important to note that during this stressful time, children look to adults for guidance, so the way you react can have a major impact on how your child perceives and reacts to the changes occurring and information presented. COVID-19 gives parents the ability to model routines, schedules, and remote school lessons in creative ways. The following tips can help:

· Children look up to you. Staying calm, collected, and informed during this unsure time can decrease your child’s fears and ensure your child has the facts. Carefully listen to your child and help your child draw or write out concerns, thoughts, and feelings, then respond with truth, validation, and reassurance.

· Explain what COVID-19 and social distancing are. Children most likely do not fully understand what COVID-19 is and why we are social distancing. Create visuals or hands on activities for your child to explain what the COVID-19 virus does and exactly why we are participating in social distancing.

· Keep a morning routine, and don’t forget to relax. Keeping up with a regular schedule, especially as things start to shift to the new normal, is important to keep your child at ease. Working with your BCBA to identify preferences for activities that are calming and relaxing in nature to your child can help. An example of an activity that may be a preference to your child is yoga, deep breathing, or meditation.

· Model basic hygiene and health practices. Encourage your child to practice regular hygiene like washing hands for at least 20 seconds, wearing a mask in public, and teaching personal space.

· Be aware of your child’s mental health. The COVID-19 pandemic has forced us to change the way we interact. This can mean decreased contact with friends and family. Pay close attention to your child’s eating and sleeping habits – if you see a sudden change, consult with a mental healthcare professional.

Keeping an open, understanding mind towards your child’s concerns can help your child adjust to the fears of going back to school in the fall and others concerns your child might have.

For more information on COVID-19 and other helpful resources, visit https://www.cdc.gov/coronavirus/2019-ncov/prepare/children.html

For more information on hand washing and hygiene, visit https://www.cdc.gov/handwashing/pdf/hand-sanitizer-factsheet.pdf