How effective is Applied Behavior Analysis (ABA) Therapy?

Just how effective is Applied Behavior Analysis (ABA) Therapy? Several studies have been conducted on the effectiveness of this therapy since it gained popularity via the Lovaas method. The great thing about this therapy is it is so comprehensively tested most insurances cover it for children with Autism. ABA is proven to be extremely beneficial.

Here are several sources that state just how crucial ABA is for children with autism:

Current Opinion in Pediatrics, 2011; Vol 23: pp 616–620: Found that behavioral interventions are effective for cognitive abilities, language, adaptive behaviors, social skills and reduced anxiety/aggression.

American Journal on Mental Retardation, 1993; Vol. 97, No. 4: pp 359-372: Children who received ABA were tested again at an older age and were found to have benefited from long-term progress.

Journal of Consulting and Clinical Psychology, 1987; Vol. 55, No. 1: pp3-9: 9 out of 19 children attained average functioning after 40 hours a week of ABA.

Pediatrics 2012; Vol. 130; S186: Forty-eight autistic patients received ABA at the age of 2, their IQ and communication improved significantly.

Committee on Educational Interventions for Children with Autism, National Research Council: States; 40 years of testing ABA has shown that it decreases problem behaviors and teaches new skills to those with autism.

American Psychological Association website: “Since medications on their own rarely improve behavior, behavioral interventions are crucial.”

ABA is not an experimental therapy that pokes and prods at your child in hopes of finding a ‘cure’ or something that might help. ABA is a proven method that will help your child with autism reach a level of skills and functioning you may never have thought possible.

What kind of therapist will be a good fit for your child?

Not all therapists will have the same style of implementing common ABA therapy techniques. Some may be very gentle, others firm, where some may want to explain situations to a child who works well with logic, and others may want to make simple demands instead. Applied Behavioural Analysis (ABA) is a therapy that is implemented in a way that molds to your child's unique personality and needs.

Because of this, not all Applied Behavioral Analysis (ABA) therapist will be the right fit for your child. When you decide to terminate services, you may consider if you want somebody else. If this is the case, think about what it was about the last analyst that caused issues for you. Understanding what you disliked about the therapist style of teaching, and communicating it to the company, can help them find you a better fit. Making a concrete list of what you are looking for gives the therapist/company a way to meet your needs, and either refer you or find someone like that.

Whether it’s tone of voice, certain techniques you don’t agree with or simply the personality of your therapist, making sure all of those issues are met to your desires are important. Never be afraid to go with a different therapist until you find the right fit for your child. Every therapist practicing ABA will bring their own unique style and personality into the mix. Just like every child will bring their own personalities into the relationship.

Emotions for an ASD child

Almost all children struggle with recognizing emotions in others, but for a child with autism, this skill is even more complex. Their inability to read body language or facial expression well lends to even more complications throughout their life, which is why it’s important to teach this skill early. Learning how to recognize emotions impacts all areas of a person's life, from school, to work, to making friends and strengthening family bonds.

One great thing about teaching a child emotions is that they have to look at faces to achieve it. Something that people with autism struggle to do. An applied behavioral analysis (ABA) therapist can teach this in a variety of ways, one way is to show pictures faces that are sad, happy, worried, angry, etc. They ask the child which face is which and have the child point or tell the therapist.

Therapists can also teach this through expressing the emotions to the child and having them identify it. They express the emotion in an overt way, by grinning and clapping and asking what the child thinks the therapist feels.

The more the child practices identifying emotions in an artificial setting, the more likely they can recognize emotions in an everyday setting. Once a child can label and identify emotions, they can move on to learning how to deal with the emotions in themselves and others.

ABA is a great tool that helps children to learn a range of complex abilities that will help them with life skills across a range of areas, from school, to home to friends. Learning emotions is just one tool of many.

Researching the Therapy

As a parent new to the diagnoses of Autism or with little knowledge of Applied Behavioral Analyses (ABA) therapy, the whole process of researching the therapy and life your child could face is overwhelming. But reading about the nuts and bolts of the therapy and what kids with autism go through, in clinical dry ways, only gives us so much information.

Researching the step by steps, understanding the language, and talking to a therapist about your concerns are all legitimate ways to discover what you’re getting into—but it can’t prepare you for how it feels or even looks like living it.

There is however a book When Everybody Cares: Case Studies of ABA with People with Autism  by Bobby Newman which is a first-person account of ABA. It can show you in a very real way how this therapy affects a child’s life and what issues arise with someone on the spectrum.

The book When Everybody Cares: Case Studies of ABA with People with Autism gives a unique insight into the life of a behavioral analysis and the solutions they develop for common problems. The great thing about this book is you aren’t just reading step by step, you're reading the struggles and insights and even the raw emotions that come along with working through difficult behavioral issues: such as a child refusing to eat or learning how to follow instructions.

Like a diary, this book doesn’t tell you what ABA will be like, it shows you like a story, a biography of sorts. ABA is a beautiful journey for everyone involved, so it’s little wonder such a beautiful book has been written because of it.  If you want to really see what ABA looks like, or even feels like, then give this book a try.

Techniques on how to encourage your child to stick out

The behavior of trying to escape a situation in all children is common, but especially so with autistic children who have a lot going on and little to no attention span.

In applied behavioral analyses therapy (ABA) avoidance techniques are tackled head on, to build up the child’s tolerance to accept and even enjoy certain situations—such as sitting down to read a book.

A child won’t be allowed to escape a situation (since this will re-enforce that escape is preferable to getting through to the other side) so what does the therapist do to make sure the child feels they can make it through that moment?

ABA Techniques: How to Encourage a Child to Stick it Out

A lot of now vs then techniques may be used. Sometimes autistic children have a hard time understanding that this moment won’t be forever. Timers are set up to show this will end and posters explaining now vs then.

Rewards are also great. Rewards such as music, and toys when they finish a task can help a child get excited to finish, instead of unmotivated and blah.

Replacing behaviors is another tool. Instead of your child running away and hiding, the therapist teaches them to ask for a break. If they ask too often, it is lined up with the other techniques and tolerance built up.

For older children the work you are doing together could be too hard, do they understand it or getting too frustrated by how difficult it is? Maybe everyone needs to step back and look at whether this is a reasonable ask.

For older children, help him/her discover their why, what positive thing they will get from learning or ‘surviving’ this task? Talk out the positives and help them view the task from a new light.

If the amount of time it takes is too overwhelming, a therapist may cut the work into parts, doing some now then taking a break and some later.

Our therapist uses awesome token systems, which are Velcro tokens of their favorite characters. Every time they complete one step they get a new token and they love it!

The Therapist Doesn’t Expect Perfection

The effort should get rewarded more than the outcome.

If your little one tried really hard but got the answers wrong, this won’t be penalized. For e.g. If we’re teaching a child to do the dishes, and stick it out, but they leave mess on a couple of cutlery, oh well! The point is they stuck it through and should be rewarded. Everyone makes mistakes and perfection isn’t the outcome we want here, it’s getting through the situation.

The therapist will always praise your child as they take steps through a non-preferred task, they deserve it. It is difficult to do anything when your world is full of noise and distraction, sometimes they just want to do something easy; but as we all know we can’t always do this as adults.

This is Something We All Do

Often ABA is just common sense. I bet you ask for help, know why you want things, take breaks and reward yourself for getting through boring tasks too! For instance,

“This meeting will take 20 minutes, I’ll learn some valuable things and when I go home and take a bubble bath.”

“I would like to be healthier for my family; I can ask my friends for help and have a special meal on the weekend. If I lose 10lbs I can get a new wardrobe.”

The procedures your ABA therapist uses isn’t alien, these are things even non-autistic people need to learn to optimize their days! And they set your child up to conquer the more uncomfortable aspects of later life, like boring work, meetings and chores.

Why your child is acting a certain way

Every child, anywhere, regardless of autism, acts a certain way for a reason. We don’t do things out of nowhere. Honing down those reasons are the key to helping a child overcome a behavior that won’t serve them in their adult years.

Let’s look at some common reasons people engage in certain behaviors so you notice what makes your child act the way they do!

Sensory

Sometimes we do things because it feels good to do them. Even though soda is bad for us, when we drink it the taste feels worth it, or the energy it gives us feels good. Sometimes we know we shouldn’t do something but we do it anyway because it makes us feel something we crave.

For an autistic child they may involve themselves in sensory stimulation, like flapping, rubbing their hands on things and spitting. This behavior is self soothing; they do it because it feels good! You may see it occur more when the child is frustrated, bored or even excited.

Escape

If you could escape from a painful situation without consequence, instead of facing it head on, would you? Most of us would!

Autistic children are known to bolt (they call it eloping now, officially) they run from situations, they hide under tables and do anything they can to escape doing something. Sometimes that something could be as simple as putting their plate in the sink. It’s not always because of doom and gloom circumstances.

A client of ours loves to use this behavior, he has several places in the house he knows is hard for adults to get to and as soon as you ask him to do something unpleasant (like chores) off he runs to hide under the bed.

There are other ways to escape situations like violence and yelling.

Children do this when they don’t want to engage in something. Maybe that something is boring, scary, annoying or too hard for them.

Attention

Yup, people do things for attention. This is a difficult one for some people to understand because it has such negative connotations wrapped around it. It shouldn’t, ‘attention seeking’ is just communicating that you want someone’s attention in the wrong way.

This is probably my middle child’s favorite reason to act out. He is a show star, he is loving, cute and by golly if he can be center of attention he will find a way! His autism (low empathy) means he often pushes children, hits them or bullies them so he can take their attention from them. It’s not about the child being a ‘bad kid’, this is just a child that doesn’t know how to say, “Hey I want a connection with you right now but I don’t know how to do it.”

Children do this when they want social interaction, or they want you to connect with them.

Tangibles

A few of our clients are obsessed with electronics. When it comes to trying to take them away the term ‘out of my cold dead hands,’ comes to mind. Sometimes children act out because they want something, plain and simple. They just don’t know how to communicate that want or they are terrified if you take it away they will never see it again.

This is the way that an ABA therapist looks at your child’s behavior, and a great thing to do for yourself as a parent. Sometimes putting meaning to situations helps us cope, and also gives us insight into how we can help our child in that moment.

Parent Training: Is your child's behavior getting worse?

How do you know whether you’re experiencing an ‘extinction burst’ or if your child’s behavior is just getting worse?

What is an Extinction Burst?

To understand what I mean by this, I’ll give an example. Let's say you ask your child to do something and they start hitting you. You've learned that not allowing escape is a great intervention so you ignore the child hitting you and repeat your request. At this point the child may start hitting more or harder (i.e. behavior just go worse).   

Why does this happen?

Because it used to work for them! This is called an extinction burst.

When you start to ignore the behavior all together they will up the ante and try to go back to the way it was before. Because that was easier for them than listening to you.

This doesn’t make your child a bad person in any way; in fact it makes them pretty smart! They’ve figured out how to get what they want in this world, and it’s wonderful. They can problem solve like this. Increasing the bad behavior is actually a clever thing to do. If you did something one way, and it worked, you would keep doing more of it to get the same reaction too!

When a behavior is done for attention, and we ignore the behavior it will get worse. But then it will start to get better, because your child will realize this is just too much work. Great!

But what happens if it stays the same? And doesn’t get better at all? When do you draw the line in the sand and try a new tactic?

What if an intervention isn’t working?

There will be plenty of data and charts to show whether your child is going through an extinction burst, or the behavior hasn’t changed at all. If the behavior hasn’t changed at all the reason your child is doing the behavior may need to be looked at again. Maybe the therapist was wrong, and they did it for another reason. If this is the case, the charts will show it and the data will help them change tactics. Some other ways the therapist could change the intervention to the behavior is;

-        Changing the length of time they ignore the behavior/child

-        Expand the plan to other places where the behavior may occur more

-        Have someone else also back up the intervention

If you feel a part of therapy isn’t working for your child, you can always speak to your therapist about it. They will have the data and charts to confirm or deny your experiences. They should work with you, not against you, to help your child better function, learn more and live a more productive life.

ABA therapy steers autistic children to work through sensory overload until it's no longer an issue

Many children with autism suffer from sensory overload. This could be sensitivity to noises, sensations, lights, textures, temperature and more. The issue with these sensory problems is they impede things your child needs to do.

We work with a boy who has autism and he hates people touching his finger-tips. Therefore, it is almost impossible for parents to cut his nails because he will scream and thrash around. But he also uses his nails as weapons to hurt himself, so cutting them is necessary. It’s a catch 22 and there are a lot of times this happens for our autistic children.

Take for example a potty; if they are scared of how it sounds or how it feels to sit on one, they won’t want to relieve themselves. It will be impossible for them to learn how to potty train. They may not like the way a hairbrush feels or a shower sounds. It hinders their life in a way you don’t always expect; sensory issues can stop your child from being able to care for them self.

That is why Applied Behavior Analyses (ABA) is so important. The therapist can use ABA as a way to run programs that eradicate this sensory issue for good. The name of one technique is systematic desensitization. This is where, a child is exposed to the stimulus on purpose and taught relaxation techniques.

For my son and his nail clipper issue it looked like this:

-        -Nail clippers were used on other people

-        -Nail clippers were brought close to him

-        -They brushed the nail clippers over his fingers

-        -They used the nail clippers to cut one nail

At every step this boy screamed and cried and fought, but eventually he could cope with that step. It became normal to him and he calmed himself.

Dealing with things like that alone is scary, especially seeing your own child in that level of fear or pain. An ABA therapist helps to steer them through these issues until they are no longer a big deal.

Parenting Styles: Techniques can influence an autistic child in many ways

When it comes to Applied Behavioral Analyses (ABA) therapy consistency is key. This is true for all parenting styles; Autistic children are no different from every other child in the world. If they can find a way to get what they want, then they will utilize it.

For instance, if a toddler wants a lolly-pop and you say no, then they ask somebody else and they say yes, they may ask different people until they get candy because it worked before. It’s important that all parents and those raising a child (because it takes a village) are on the same page.

An ABA therapist in effect helps you to raise and teach a child who doesn’t respond as well to traditional teaching methods we as caregivers see in our own families and mainstream media. Because consistency is paramount, it’s imperative you keep constant communication with your therapist. Moreover, all parents involved are on the same page. I say this because one parent, one caregiver, or one daycare/school can undermine an entire week of ABA therapy if they aren’t clued in to how everyone is reacting to a behavior in a child.

It’s the two steps forward one step back issue. If you want ABA to run smoothly and quickly, allowing anyone to take the child a step back will make the process much longer.

If your child attends a daycare, goes to school, has separate households and more than one set of parents, every single person needs information on what techniques are used in certain situations.

ABA is a very effective but easily undermined therapy. This is why having a therapist you trust enough to implement all of their ideas, will make your ABA journey smoother. This is why communication across all platforms will ensure ABA works as well as it should.

If you ever feel that ABA isn’t getting the results you expect, you need to investigate and ensure that everyone is on the same page, and has followed through with the techniques correctly before changing them up or ending ABA all together.

Can an ABA Imitation Program work for your child?

One of the first things your Applied Behavioral Analysis (ABA) therapist may work on with your child is imitation. This is a program your therapist teaches if your child is babbling and attempting speech but won’t speak when asked a question, or cannot repeat something.  

Being able to imitate somebody is so important for learning social skills, mands and how to learn from others. And since children with Autism learn a little differently than their peers, it’s vital to teach them this key skill in a way they can comprehend.

How an Imitation Program Works in ABA

If you want to teach your child new words and new behaviors they have to copy those behaviors, right? If they can’t copy the behavior, then they can’t learn how to do the behavior.

This is where the therapist steps in and shows a behavior or phrase to a child. This could be something silly and totally out of context, like, “say itsy-bitsy”. The child repeats this, and gets a reward. Later on another child might hop, and your child may imitate as they have learnt how to.

This program is also used in every day context, such as, “say I want juice” or “a cookie” to receive the desired item. Instead of whining, repeating your sentence or gesturing, the child will begin to learn to say “I want juice” instead.

But My Child Can’t Imitate At All!

When your child is completely non-verbal and has a hard time saying anything at all, words are broken down into pieces and taught over time. For example, “say mommy”. The sound “mo” is taught first and rewarded, then mom, then mommy.

What Issues Could Arise?

There are a couple of behavioral ‘issues’ your child could pick up from this program, but nothing that won’t be reversed with ease.

We had an issue recently where an autistic child repeated everything. The therapist would say, “do this” and touch their head, and he would say, “do this” and touch his head. This is a common problem in autistic children who practice echolalia (repeating phrases automatically). It can be fixed easily! Our therapist simply dropped the phrase, “do this” and so did he!  

ABA is an excellent therapy for teaching a child with Autism the skills he or she will need to move through life, and learn from their experiences. Imitation program are just one of the skills implemented to encourage this.

How your child can wait in a structured way

It’s hard for our children on the spectrum to control impulse control and emotions related to frustration. Because of this, asking them to wait is akin to asking them to stop their world from spinning. The end result? It gets frustrating quickly; they may explode, tantrum, lash out, whine, repeatedly ask, and destroy property, or any number of things to stop the waiting period.

This is why with applied behavioral analyses (ABA) your therapist teaches your child how to wait in a structured way.  First the therapist may start by reducing the waiting period to a miniscule amount of time; usually 5 seconds.

The therapist will hold a toy, and when the child asks for it, they will say wait, and count to 5. If the child can wait those 5 seconds, great! They receive the toy and all is good with the world again. If this happens regularly, the time will increase from 5 seconds to 10 and so forth.

But if your child throws themselves into ‘negative’ behaviors, the therapist will stop the program until the child has calmed down, and try again. If the child continues to engage in problem behavior that’s no issue! The therapist will simply stop trying and move the situation to something else.

As long as the adults teach the child to wait, eventually this hard lesson will sink in, tolerance for this situation will be built, and you will have a child able to wait. Teaching a child how to wait has so many long term benefits. As an adult we have to wait for many things, lines in stores, for a package to arrive, for somebody to finish using what we need, etc. If an adult couldn’t wait it would severely impact their relationships and happiness later on. Which is why therapies like ABA are so important.

How your child can perform tasks successfully

Sometimes your child doesn’t have a skill that his peers have. Recently we’ve had problems getting an (almost 4-year-old child) to remove his shirt. This is obviously a skill he should be able to do by now if he was developmentally normal but alas Autism has him behind others his age in many ways.

There could be plenty of skills that your child has yet to achieve too! Such as; washing their hands, putting on clothes or brushing their teeth, etc. But that doesn’t mean there is no hope. Applied Behavioral Analyses (ABA) therapists have a specific technique for teaching skills like this and it’s called chaining.

What is Chaining?

Well, we can break it down like this. Almost every skill has a series of steps attached. For example, when you’re learning how to make a salad, you don’t go from someone who’s never seen a salad bowl to a bowl full of salad. First you have to look up a recipe, and then set out your ingredients, cut them up, put them in a bowl and add dressing. This example had five different steps involved that we don’t even think about, but for a child learning a new skill those are all the steps they have to learn to get the result of a salad for dinner.

A therapist can’t show an Autistic child how to do something and expect that they’ve understood their complex language, have the motor skill available, remember every single step, then execute it perfectly. Because of this they use chaining.

Chaining starts by teaching a child how to do something either backwards or forwards (depending on what is easiest). Take the example washing hands, this can be placed into steps like so;

1.     Pull the stool up to the sink

2.     Find the soap

3.     Turn on the tap

4.     Get your hands wet

5.     Apply the soap

6.     Rub your hands together under the water

7.     Rinse the soap

8.     Put away the soap

9.     Turn off the tap

10.  Get down from the sink

When chaining forwards a therapist will prompt step 1, then re-enforce it until the child can perform this task perfectly three times. They then move on to the next step, and so on and so on, until the child can perform all ten steps without prompts.

When chaining backwards the therapist completes all nine steps for the child, then prompts the final step. When the child completes it on their own, they get positive re-enforcement. They then complete steps 1-8 and prompt 9, and so forth.

 This technique is not only fun for the child, with lots of praise and very few errors, but it can teach a child how to perform almost any task successfully. This way they can lead a more independent life. Using this technique my son went from not even caring if he could take off his own shirt, to removing his own shit just by asking him to, within a week in an excited happy manner.

How to help your child with scrolling

Recently a family had trouble with their 2-year-old autistic son scrolling. Scrolling is when your child goes through several answers to a question before landing on the correct answer. This could look something like;

You hold up a picture of a cow > instead of saying cow and getting the reward your child says > duck, dog, cat, cow!

Whenever a new quirk in your child’s behavior arises you should always talk to your therapist about it so they can draw up a comprehensive plan, but there are some generic answers to this problem; which are commonly used by applied behavioral analyses (ABA) therapists.

A lot of ABA therapists seem to agree scrolling happens when the child’s error-correction isn’t performed correctly by the therapist.

What this means is, when a child is learning what a new response it is up to the therapist to prompt the child from most invasive, to least invasive.

‘A ‘most invasive’ prompt would look like “what is this shape?” And when the child doesn’t respond correctly the therapist immediately prompts them by telling them the answer to be repeated, then praises them. The least invasive method would ask the question and then wait for the child to answer it correctly the first time without prompts.’

Sometimes a child wants to give the correct answer a little too badly, and repeats a bunch of answers in hopes to land on the correct one. The scrolling could then occur when the therapist allows the child to reel off answers and praises them when they land on the right one regardless of all of those errors. Funnily enough, now the child has learnt that, cat, dog, cow, duck, is what you say to get a reward when shown a duck.

But it’s not too late to reverse the problem! Your child won’t do this forever. All the therapist has to do is clarify that spieling off ten words until they get to the answer isn’t the correct response to the question at hand.

To do this, when the child starts to scroll after a question is asked you pause, make it clear they are to wait, and then you re-introduce the question. If the child continues to scroll after three attempts, ask the question and use the most invasive prompt to illicit the correct answer, then praise.

A method like this, or something similar, is likely what your therapist will do to correct this charming, and a little bizarre quirk that a lot of children with autism develop especially as early learners. It is a simple problem to both develop and fix and should be no problem for your therapist to help your child overcome.

Terms that can be useful during ABA therapy

As a parent Applied Behavioral Analyses (ABA) uses a lot of jargon words that leave us confused and wondering what the heck the therapist just told us! Arming yourself with the professional language of ABA will help you understand what the analyst or therapist may be saying when discussing your child with you (or even each other).

ABA – Applied Behavioral Analyses.

ABC – A three step behavior process that stands for, antecedent, behavior and consequence.

ASD – Autism spectrum disorder

Abscissa – The horizontal line graph that measures the time a behavior occurs.

Active Behavior – A behavior which can change, such as running, jumping etc, sitting still is not an active behavior.

Active Responding – When a child is expected to behave by solving problems, speaking, writing etc rather than just listening.

Advocate – Somebody who speaks out on behalf of a person.

Americans with Disabilities Act – Federal civil rights law protecting those with disabilities.

Annual Goal – A goal that you wish your child to reach within a set time period.

Antecedent – What happened before a behavior.

Approach – Choosing which form of treatment will be used, ‘the approach used’.

Augmentative Communication – Any communication made without using speech, such as pictures, sign, or electronic devices.

BCBA – People with this qualification are able to oversee and supervise programmes.

Behavior – Not always something bad, this is when a child does a behavior that is measurable, such as a meltdown or manding.

Chaining – This is the word used to describe when a therapist teaches a child a task using multiple steps. These can be taught backwards or forwards and still be successful.

Chronological age – How old the child is biologically.

Cognitive – Referring to thinking skills, which includes receiving and understanding information. This could be done by placing a square in a square shaped slot by understanding where the square needed to go.

Consequence – What happens after a behavior occurs.

Consultant – Anyone your therapist consults with/creates plans with, or a person who trains people.

DSM – Diagnostic manual for all mental disorders. This let’s a therapist know the criteria for each diagnoses.

DTT – Discrete trial training. This is when a skill is taught multiple times, usually by giving a demand and expecting a specific response, followed by praise.

Deprivation – When a motivator is removed/lessened so it is very desirable.

Development age – How old the child is ‘developmentally’, measured by tasks and skills they can complete based on the neurologically typical age range for those skills.

Developmentally Delayed – When a child is delayed compared to their peers.

Echoic – When you ask a child to repeat something and they repeat it on demand.

Echolalia – Where a child repeats what is said back to you almost compulsively. So instead of answering a question they repeat parts of the question, or the entire sentence.

Elopement – The official term for a child running away, or bolting.

Environmental Modification – Where the environment is changed to reduce barriers affecting instruction, behavior and teaching.

Expressive language – The use of language to convey meaning.

Extinction burst – When a child suddenly starts doing the behavior more often, or at a higher level, once a re-enforcer is removed.

Extinction – Removing what re-enforced your child to do something, such as giving attention to whining, which results in the child doing this less.

Fine motor – The small movements you perform with your body. With Autism you may see that a child has a hard time picking things up with his/her fingers or writing.

Floor-time – When a child moves away from table-learning, this is often child led learning.

Generalization – Being able to apply what you have learned to all situations. Such as learning how to ask for juice in therapy, then asking the same way at home.

Gross Motor Skills – Large muscles in the body perform gross motor skills. This could be jumping or running.

Hand-Over-Hand – When a therapist will literally move your child’s body to show them what they mean by a demand. For example, they may ask them to pick up a block and when the child doesn’t understand or refuses, they will take their hands and help them pick up the block with plenty of praise.

High functioning Autism – A child with Autism who has a great grasp of age appropriate skills but is unable to socialize with ease.

Hypersensitive – Very sensitive to outside stimulation.

Hyposensitive – Not at all sensitive to outside stimulation.

IEP – Individualized education plan. A legal document outlining the educational plan for your child when they are considered to have special needs.

Intervention – Using a plan of action to change an undesired behavior.

Intraverbals – When a child uses speech without visual prompts, such as being able to tell you what they did at school that day.

Level, 1, 2, 3 – Under the DSM criteria each level requires more and more support, with 1 being minimal and 3 being substantial.

Low Functioning Autism – A child who is quite delayed, may not speak etc.

Mand – This is a verbal criterion, and is when a child uses words to ask for something or make a demand. This is usually the first form of language that children learn. Juice, when asking for juice, would be an example of manding.

Mouthing – When a child puts things in their mouth.

NET – Natural environment training is child led therapy or learning from the current environment.

Neurologically-typical – Another way to say ‘normal’. This is when a child develops at a normal rate.

Normal – When a child develops normally. Some people may find this term offensive.

Peer-Mediated – When a child a similar age to yours is trained to interact with your child and teach social skills.

Perseverative Behavior – When a child engages in excessive, repetitive behavior that is not stimming such as asking for an object several times in a row.

Picture Exchange Communication System – Or PECS is used when a child has limited verbal skills, often they are given pictures to exchange with you in order to communicate.

Pivotal Response Training – Where a child is taught pivotal areas of development which are targeted to affect several areas of development at once.

Prompt dependant – When a child has gotten to the point where they consistently need to be prompted to do a specific task and won’t do the task independently.

Prompt – When a therapist prompts a specific response they are looking for, this could be verbally, physically, visually etc.

Punisher – This does not refer to punishing the child, but rather a consequence of an action which reduces a behavior. This could mean having a child move away from a situation where they are being disruptive and being allowed to re-join once they behave appropriately, in this case it could both protect the child and other children/objects involved.

Re-enforcer – When a child is given a motivation to complete a task, such as a favorite toy.

Receptive Language – This is ‘good listening skills’ where a child can follow directions that are non-verbal.

Recovered – When a child no longer fits the diagnostic criteria for ASD.

Regression – Where a skill a child previously knew has reduced or vanished from their repertoire. Or when a behavior eradicated many years ago, comes back.

SLP/OT/PT – Professionals who help with areas of the child’s development. Speech and language therapists (SLP) help with speech delays, OT helps with occupational therapy issues (play), Physical therapists help with fine and gross motor skills.

Satiation – When a re-enforcer no longer works because it has been over-used.

Scripting – A verbal stim of some sort, such as a song that’s repeated over and over.

Scrolling – When a child is asked a question and they go through several responses before reaching the correct response. As in; if they are shown a circle and they say, square, rectangle, circle!

Self-Injurious Behavior – When a child hurts themselves purposefully.

Sensory Integration – Tools used to help a child reach internal sensory needs, this could be a weighted vest or blanket.

Shadow – Somebody who follows your child around in the classroom as a helper.

Stereotypic/Repetitive Behaviors – Also called stimming, this could be repetitive motions such as spinning and flapping.

Tact – A tactile is a verbal term, this is where a child can name objects they can see.

Target Behavior – A behavior the therapist is interested in increasing or decreasing.

Task Reduction – In some cases a child is frustrated by the amount of demands put on them so they are reduced to help increase success levels.

Transitions – A lot of children with Autism have transition issues, this is issues with moving from one location to another or one activity to another.

VB – Or verbal behavior; a branch of ABA that concentrates on speech behavior.

Variable Ratio – When a child is given a demand, or is expected to make a response and is given a re-enforcer every set amount of times. For example, 3-5, the child receives a re-enforcer every time they complete a task 3-5 times.

Vocal/Verbal vs Non-Verbal/Vocal – When a child can use language or not.

 

Asking questions about your therapist being too hard or too soft on your child can be a learning experience

Applied Behavioral Analyses (ABA) therapy is about teaching your child life skills, academics, and positive behaviors in a fun environment. Sometimes that means your therapist may do something you don’t always understand. It’s always best to ask why, often, as once you understand you too can apply it at home.

One common question parents often ask is why the therapist is, or isn’t placing demands on a child, especially if the parent has done something entirely different regarding a behavior.

Is the Therapist being too hard?

Sometimes when a therapists places lot of demands, a child with Autism tantrums. However, this does not mean that the therapist should punish or spank.

 Many times you will see an ABA therapist holding a child still, forcing them to do things, or to sit still until they stop tantrumming instead of typical punishments like removing a toy, or time out. As a parent, this can be uncomfortable as we often go into survival mode and try to stop whatever has upset the child. Or bargain with them, or put them in time out, or any myriad of techniques that seem appropriate at the time.

An ABA therapist is unafraid of the meltdowns. They place the same demands that anyone would place on a child and hold them to it, sometimes literally, in a safe place.  

Is the Therapist being too soft?

However, on the other end of the spectrum you could ask, why is my therapist not jumping on the bad behavior enough?

Sometimes this is a legitimate concern and perhaps your therapist needs to consult with their team better if they are encouraging certain behaviors to continue. If you notice your child has started a new behavior because of what a therapist is doing, always consult the analyst or therapist. Sometimes therapists get it wrong too.

For example: Our child once started purposefully engaging in ‘bad’ behavior to find opportunities to get a demand. This was because, during therapy time when given a demand, he got a piece of candy for performing it correctly.  Of course, 40 minute long tantrums ensued as he stole items, gave them back, and then demanded candy for his confused version of good behavior. Looking back, it was a little funny to watch a child run with glee through the house as he stole his sisters night shirt, only to immediately bring it back, then head to the candy jar all proud of himself…as I stood there completely baffled. But at the time it was a confusing experience for everyone involved. We fixed this by speaking to the analyst who banned candy as a re-enforcer. The issue was remedied in less than a day.

But there are other reasons a therapist may not be addressing the behavior. Some techniques involve ignoring a behavior altogether until it naturally falls out of the child’s tool-box. Perhaps they’re licking the table and making silly noises because they think it’s funny, but actually this could be totally unhygienic if they were to do it outside of the home. Here, the therapist may ignore it until the child forgets about doing it because they’re not getting any fun out of it.

Another reason your therapist may not be addressing behaviors yet, is when therapy first begins. Therapists will go through a ‘honeymoon’ stage with the child when they meet. This is where they play, get the child to love them, teach them they’re a fun person and everything will be great. If they come down too hard to begin with, your child won’t want to be around them since they haven’t learnt this person is a fun person to play with. And ABA therapists believe a child HAS to have fun to learn.

 

It’s always best to ask questions that come to mind with your therapist— it can be a great learning experience for everyone involved, not just your child. This is somebody who will be working with your child for perhaps years to come, and being on the same page with their nuances will make everything run a little more smoothly.

 

Tips for Potty Training

Autism can cause a host of issues when it comes to potty training and there are many reasons. Some of these issues stem from a general development delay, communication issues and anxieties that accompany toileting.

The Trouble with Communication

There may be some problems with communication where the child is unable to express that they need the potty, or do not understand the line of questions associated with the potty such as: “Do you need the bathroom?”

Even body language can be a problem with children who have Autism; you may notice that your child has no warning signs before an accident, such as playing with their underwear or jumping up and down.

With Applied Behavioral Analyses (ABA) techniques like Verbal behavior methods or PECs can teach a child to understand and communicate more efficiently so fewer accidents happen. Specifically a visual schedule or social story can help a child who has trouble understanding language; this is several pictures showing what will happen when a child goes potty, from sitting on the toilette, to wiping, to washing their hands.

Sensory Issues and Potty Training

Another common issue for Autistic children is the sensory side of using a potty or diapers. Sometimes the bathroom is colder than other rooms in the house, the floor could be cold, the potty hole could be too intimidating, the diaper could comfort, the child may need a stool to stabilize their feet and may detest the sound of the toilette flushing. These are all things that spike anxiety and make potty time unpleasant. Most of these things can be adjusted, explained, and worked through together.

Make Potty Time Fun Again

As with many classic ABA methods, re-enforcers encourage a child to enjoy their potty time. This could be rewarding them with stickers, candy, or a special toy every time they successfully use the potty. Some parents use a special toy area that the child has access to after they have successfully used the bathroom. You can set this up in the corner of the room or in the bathtub.

Transitioning to the Potty

Finally, children with Autism often have transitional problems. This too may impact your potty training in a way that ‘typically developing’ children may not have to deal with. Moving straight from an activity or location can be traumatic for a child with Autism and they may have accidents to try to avoid potty time all together. Giving plenty of warning and being consistent can help.

 

ABA therapists have strategies for every situation that occurs, and they have probably seen it all before, or at least heard about it. This will make potty training so much easier on the parent and guarantee a greater chance of success.

Understanding how ABA therapy works can help your child out in many ways

As a parent involved in Applied Behavioral Analyses (ABA), it’s fantastic to jump in with two feet. At first it can be a scary experience, watching your child tantrum as the therapist waits it out when you’re used to soothing—and let’s be honest, panicking. But there is also a blissful feeling of control that comes with the charts and numbers applied to these things.

Our therapist had us tracking tantrums and your ABA therapist will likely do the same. How long where they lasting for? How many incidents of property destruction, violence, or self harm occurred? How bad was the destruction, violence or self harm? Suddenly this overwhelming experience becomes a numbers game. You detach from that fear and become a detective, getting to the route of the problem.

“Yes, he/she tantrumed for 20 minutes today, but looking back in the chart we can see they also tantrumed for the same amount on this day last week. Perhaps an incident of property destruction has gone down by one or two times in that last week? Perhaps we can identify something different about that day causing more tantrums?” Each reduced number and dash on the page becomes a little ray of hope.

ABA isn’t just a therapeutic experience for the child. Suddenly you’re not alone in this world of crying, screaming or strange and wonderful things your little one does. Here is somebody by your side, battling this world with you and your child, helping you navigate it together. And if you’re anything like me, you begin to miss these moments you share with another human being who understands your child’s nuances as well as you do (and sometimes even more). 

Jumping into ABA with two feet is scary, but it can be the most rewarding thing as a parent you could ever do with your Autistic child. Like being handed a magnifying glass to see into the cogs and turns in their mind. Finally you have the tools to conquer the behaviors, understand them, and help your child get to the other side of Autism. 

The impact of relationships for family and friends of an Autistic child

When there is disruption in the household between two people it affects everyone, and that can happen a lot with an Autistic child. Siblings of Autistic children may not interact with their ASD brother/sister, or there may be arguments and misunderstanding between them. This happens a lot because let’s face it sibling relationships are difficult as it is, but throw in a child who has trouble communicating, playing outside of their comfort range, with little understanding of social interaction, and there’s bound to be some issues. This isn’t anyone’s fault and the great thing about Applied Behavioral Analyses (ABA) is this can change for the better!

First it must be remembered that the other sibling may be hurting in this scenario. They often have a lot to take on with their Autistic sibling already; they may feel alienated, burdened, ashamed, guilty or frustrated. This is why it is not only the ‘typical’ child that should engage and interact. The Autistic child should be encouraged to join the other sibling with whatever they are playing. This can be done by physically moving the child to that location, following them and using encouragement. The caregiver should be with the Autistic child giving praise, support and allowing the other sibling to feel as if their brother/sister has entered their world.

Another technique that your ABA therapist may use is simple free play. Playing in the same area as each other in a new environment, such as a ball pit, play pen or the beach will foster a positive experience together. Which will help to build bonds; just as it would with another other siblings in the world.

Lastly, your therapist may have the other sibling reward the child with Autism. They could have your ‘typical’ child give the child with ASD a treat when they complete a task so the child with Autism recognize the sibling as somebody positive. After all, children of all ages work well with praise and build confidence and positive relationships upon this, why not get the other sibling involved? 

ABA can work to make any relationship stronger between your Autistic child and the other party, and sibling relationships are precious.

A key piece of self-management puzzle is trying to identify emotional states and how they impact relationships

Emotional regulation for an Autistic child or adult is an important skill to have; being able to read body language and know when your behavior is appropriate can help you keep relationships and jobs.

If your Autistic child can’t recognize emotions in others or explain their own emotions, it can lead to a lot of undesirable behavior. They could get aggressive, they could bully, they could say inappropriate things, lose jobs, break relationships and much of it could be down to a misunderstanding.  Because an Autistic child doesn’t look at people’s faces often, or make eye contact, they miss a lot of the social interaction cues that babies learn early. Applied Behavioral Analyses (ABA) aims to put this development back on track. There are a few ways this can be done. One is with a picture system where each emotion is shown and the child points it out. Another is by displaying the emotion on your face, exaggerating it, and teaching the child to recognize it. But ultimately, the therapist will be aiming to make social interaction rewarding for your child. The more social interaction they are exposed to, the more they will learn through opening up discussion, and encouragement. Another way that therapist teach older children who have begun school, is with social stories. These are basic, short stories that explain a social scenario. They run through emotions, situations and appropriate way to respond to scenarios in a form that a small child could understand. 

Once a child understands emotions in themselves and others, it will be easier for them to read situations and react appropriately. Keeping their relationships healthy and giving them a much needed skill that they can utilize for the rest of their life.