Susan's Blog

Thursday, December 18, 2008

Reductio et Absurd-ish, um

My latest column for the Brookline Tab is about my winter inertia. It is also about Nat coming home for December 23-January 5. I am so psyched for that. Of course, nervous too. But not dreading. Honestly, I used to dread those long vacations with him. I never knew what I was supposed to do. Was it okay to let him lie around, watch Disney, suck his thumb, and talk to himself? Wasn’t I supposed to create schedules — and follow them?! I am famous for making beautiful structured plans and then, well, it ends up happening but not at all the way I had laid it out. Poor Nat! If he is supposed to need/crave structure, he got born to the wrong Mommy!

I say that because I secretly (well, not anymore!) believe that it is not that simple. Nat is not that uncomplicated. Sometimes he does so well with structure; other times, he leaps up with joy at the sudden change in plans. Which usually comes from me. The rest of my family is much more — how to say it with love — tree appendages mired in moraine — and I, well, I am more on the changeable, mercurial, “moody” end of the spectrum.

That is what I hate about diagnosis. It reduces people. As the Latin phrase goes, that is an absurd practice. People are so multifaceted, we don’t even know what goes on inside the other 90% of our brains (this may be an urban legend, according to Ned, but it suits my purposes, so…) The truth is there, nevertheless, give or take a percentage point. You see where I’m going with this.

I just hate the rules. “He needs structure.” “He needs consistency.”

“You have to let him go.” Well you have to shut up.

11 comments

I agree. I have been thinking along the same lines for the last few day. Meghan is coming home tomorrow for the week and I will let her pretty much do what she wants–like hanging out in her pjs and watching too much tv as opposed to do what school does (with their team of teachers) and keep her on a tight schedule…the guilt thing rolls in, but she’s on vacation too–are they not? Plus no one lives the life school provides..SO MUCH PRESSURE

— added by Holly Nappi Collins on Thursday, December 18, 2008 at 8:04 am

The ABA T’s told me I had to plan my house. My youngest son’s Dev Ped said “DON’T”!!!! I don’t. And geez, everyone’s doing just fine.

I use to feel guilty about letting them just hang out like other kids. I still do… I admit it… but I’m getting over it b/c sometimes you just have to have a holiday.

S.

— added by farmwifetwo on Thursday, December 18, 2008 at 8:43 am

I don’t think you have to mimick school but I think kids need structure and consistency. I know I wouldn’t allow constant self-stimulatory behaviors when they were home or allow the child to have the run of the house with bad behaviors. I think ABA is 24/7 but not in a bad way. ABA is just a way of life and the structure and systems are part of what makes the kids secure and manageable. So many times that is the reason why skills and behaviors don’t generalize from school to home. The consistency gets lost or ignored. As they say, autism doesn’t take a vacation.

— added by Anonymous on Thursday, December 18, 2008 at 10:17 am

Now, now, don’t get me wrong, I do give all three of my children consistency in terms of expectations: good behavior, eating properly, kindness, doing chores, getting exercise. And I do think ABA, humane ABA, has its place for teaching new skills such as phone use and street safety, even attending in school. But when it comes to stringently regulating a person’s joyful means of expression during a Christmas vacation, I think I have to pass on that one. I don’t believe ABA is a way of life; I think it is an educational tool. I think that positive reinforcement is a good way to teach children, and I think repetition is also effective at times. But a way of life? Not sure I understand what you mean, but I would like to if you want to explain more.

— added by Susan Senator on Thursday, December 18, 2008 at 10:50 am

My son has always had a problem with routine changes, even good changes like Christmas and vacations, which he loves. There is just something about the not getting up and doing things the same way at the same time every day that that can cause him to be stressed. We just take it one day, one minute at a time and I usually am to one to put out the “fires.” The wonderful aspect of Christmas for Matthew is that he has no concept of greed, or wanting the hottest toy, and the things he enjoys most is this: the good food, all of the decorations, and endless Christmas songs, which he starts to listen to around the first week of November. My two girls get a terrible cause of the gimmees but Matthew has no concept of greed. Baking cookies and decorating is all he needs to make him a happy guy. And I appreciate that a lot!

— added by Sharon L. on Thursday, December 18, 2008 at 11:14 am

Sorry this is so long but I think Dr. Bobby Newman, BCBA, NY always explains this the best. This is from one of his conferences plus his book "Graduated ABA" spells it out very well.

Consistency is the key. If a child on the spectrum knows they can freely self stim and have behaviors because people think they need "down time" (this does not include non-contingent access to stereotypy which is a valid technique but run within the context of a token system and DRO which should be spelled out in the behavior plan) regression in behaviors or skills occur. I see it all the time. Additionally the lack of proper generalization of skills and behavior from school to home (because the school totally fails to program for it) is just a disaster and one of the biggest problems in the industry. It's not the fault of ABA but of bad teaching.

Also, stating that a reaidential child will come home and be allowed to "do what she wants" is just the kind of nightmare ABA providers have to deal with regarding some parents. The staff will spend the next week undoing all of the behaviors that were permitted or reinforced. Sorry, but that's a fact.

Topic:"ABA IN PLAIN ENGLISH" Presenter: Dr.Bobby Newman, PhD BCBA *with special guests Chris McAuliffe and Anne Beirne*

Ok, here we go, once again a TON of vital info especially for new parents and family members….(actually for our service providers too!) Get ready for a really long but good one (but not NEARLY as good as when you get the opportunity to see Dr. Newman Present)…….

Applied Behavior Analysis is a scientific discipline. ABA in not a bag of tricks, a table and chair, specific teaching procedures, specific curriculum, or a related service. It cannot be "modified" or "eclectic". It is a 24 hour way of life based on principles of behavior and learning.

Some make a distinction ABA vs. VB vs. PBS…important to realize it's all ABA. Behavior Analytic thinking process is important-once you get the thinking process down, it all falls into place, here is some basic vocabulary and principles to understand. Learn how to figure out behavior ("why does he do that?") and understand the significance of behavior-> consequence relationship. (tip: to learn more about these terms and more commonly used terms in ABA, Dr. Newman and collegues have a new book called Behaviorspeak that can be bought at http://www.difflearn.com or amazon)

ABC's of ABA: Antecedent: What happens before a behavior (also know as the Sd – discriminative stimulus) Behavior: something that moves through space; a response; somthing you do; actually have to see it happening. Behaivor goals must pass the "Dead Man's Test" Anything a dead man (person) can do is not a behavior. Go over your child's IEP and see if behavior goals pass this test. Awesome tip: Bobby pointed out how this is a problem with potty training. People reinforce "having dry pants" (dead people can have dry pants) instead of only reinforcing when the child eliminates in the toilet (dead people can't elilminate in the toilet) When you reinforce "dry pants" you are only teaching the child how to hold it in. Consequence: What follows a behavior, either making the behaivor more or less likely to occur. A: Mom says "Touch your Nose" B: Child touches his nose C: Mom says "great job!" which her child loves social praise so "great job" acts as a positive reinforcer (positive because it was given, not because she said it nicely :0)

Reinforcer: A type of consequence. Anything that will make a behavior more likely to occur (increase). Reinforcers are individual. What is reinforcing for one child may be punishing to the next. Reinforcer assessments are important to conduct on a continuous basis. Reinforcers have to be discovered. Punisher: A type of consequence. Anything that will make a behavior less likely to occur (decrease) Positive: Adding to; Negative: Removing; taking away Positive Reinforcement adding/giving something to increase a behavior Negative Reinforcement: removing something to increase a behavior ex.=Johnny hits himself to get out of a task: when you ask him to touch his nose, you stop the session. Antecedent: touch your nose Behavior: Johnny hits himself Consequence: you remove demands. Removal of demands (negative) increased (reinforced) Johnny's hitting himself to get out of a task.

Positive Punishment: adding something to decrease a behavior

Negative Punishment: removing something to decrease a behavior Time Out: A form of negative punishment. Reinforcer is lost temporarily. Often misused. This doesn't mean you have to remove the child and put them in another room or special chair. This means a "Time Out" from a reinforcing item or activity contingent upon the inapporpriate behavior being displayed. Ex.= If your child gets to close to the TV, time out the show until they step back, then put the show back on.

Establishing Operation (EO): This is the setting event, the thing that happens before the A->B->C. This can refer to the state of deprivation and satiation which will influence how effective your reinforcers will be and can help to capture and contrive salient teaching opportunities. A setting event can also be the child's state of being, if they didn't sleep well, or is sick, this setting event may effect their responding. Bobby explained how even though EO's have always been a part of ABA, it is not until recent years attention has really focused on the importance of paying attention to EO's. Another ex. is when those who work with our children pair themselves with reinforcement, they also become a setting event. When the child sees them, they know things get better, influencing the ABC relationship.

Extinction: When you no longer reinforce a behavior that has been previosly reinforced for the function of which it was serving. When you do an extinction procedure, the effect will get worse before it gets better; aka extinction burst; the behavior will burst in frequency, magnitude, and variability. You must think about how bad a behavior can get before you do an extinction procedure. The key is to either do it the whole way or don't do it at all because if you reinforce any of the more intense behaviors during the extinction burst you will wind up with a worse behavior then what you started with. Ignore the behavior not the child.

Continuous Reinforcement: When a behavior gets reinforced everytime it happens. Ex. Soda Machine. Your behavior of putting money in a soda machine is maintained by continuous reinforcement of always getting a soda (and if the soda doesn't come out what do you do?

Extinction Burst: kick the machine, hit it, rock it etc until you give up) What's stronger then Continuous Reinforcement?…

Intermittent Reinforcement: What machine do people continuously put money in even though they may or may not get something out of it? Slot Machine. Reinforecement doesn't happen all the time. This is the best way to make a behavior strong but can also be the worst form of reinforcement to use during a behavior plan. Crucial to be a soda machine during a behavior plan not a slot machine.

"the only thing I might look at is that intermittent reinforcement is GREAT when you WANT to keep seeing a behavior. it's during those reduction procedures that it can get ugly 🙂 "

Bobby talked about generalization and how it has to be programmed for. Failing to generalize skills is one of the characteristics of Autism and family members play a critical role in generalization. Vary Sd's, vary stimuli, vary settings. This is why teaching children all behaviors in distraction free 'cubbies' rarely generalizes. You need to teach the behavior under the function you want to see. ABA is a data
based discipline. The second A in ABA stands for Analysis. We need enough data to know the teaching technique is working or our behavior plan is working. (my own comment: there is no one right way to take data.

For my son it depends on the program or target, or how much trouble he may be having acquiring a skill. It is also important because data often catches the variable that is effecting his acquiring a new skill which is usually for us an inconsistancy or misunderstanding among teachers. if someone says "it can only be done with this data sheet or "it's only done like this in ABA", be wary) Data does not have to be collected in blocks of 10. People usually do that for easier calculation. (for more on data and DTT see my past notes on Taking the Trial out of Discrete Trial Teaching)

Bobby also went into specific steps and examples about shaping behaviors: The creation of a new behavior by reinforcing approximations to a desired behavior. And how important it is for everyone to be on the same step. He talked about chaining: combining several smaller behaviors to make a long complex behavior (like brushing your teeth or dressing) You can do this in a forward (first to last step) or backward (last to first step) process. Either way, you must do a task analysis (list of exact steps it takes to complete a behavior) as a starting point. A task analysis for one learner may consist of 7 steps, while a task analysis for that same task for another may take 107 steps. And how and ways to prompt the learner using most to least or least to most prompting.

Prompts are for fading, prompts are not meant to be life long. (my comment: again, there is NO one right way to prompt, depends on the learner, the program, the target, the moment. When someone says "we ONLY use no,no prompting or we ONLY use errorless" be wary) It is important to know what prompt level the learner is at.

*Now that we had all these principles and definitions understood, we learned ideas on how to apply them to effectively teach play when Chris McAuliffe presented on "The Art of Teaching Play". She explained how play is important to: increase constuctive use of free time, increase independence, and to encourage language and test ideas. She talked about the developmental progression of play 1. senorimotor 2. constructive play 3. dramatic play 4. role playing 5. games w/rules and how to use this guideline combined with assessing your childs current level and preferences to figure out where to start. Strategies include: DTT, task analysis, chaining, play centers (replicated at home), social stories and play coaching. Just a few references Chris gave to learn (most can be found at http://www.difflearn.com) more included: Pathways to Play, A Work in Progress, Teaching Playskills to Children with Autistic Spectrum Disorder, and Activity Schedules for Children with Autism (Great job Christine!)

Bobby then talked about the function of behavior, central question: "Why is he DOING that?" Not why did he start. What are the variables maintaining the behavior now?. Often what starts a behavior isn't what ends up maintaining it. Define the behaviors in such a way that everyone can agree when it has happened and when it has not. Make up a clear definition. ex: Agression includes: …… Agression does not include:……

Effective Behavior Management requires two things: First: You must pick the correct variables maintaining the behavior. If you dont have the right function, you can make the behavior worse. Second: You must then carry out the treatment plan porperly and consistantly. INCONSISTANCY IS WORSE THEN DOING NOTHING! (for more on Functional Analysis look up Functional Analysis in Behaviorspeak)

— added by Anonymous on Thursday, December 18, 2008 at 12:07 pm

It’s one of the most confounding thing about autism. Structure is good, but rigid conformity to routines can be a trap for us. We purposely change up the route home from school, we alternate techniques to keep Jared on his toes. It helps me maintain being the one in charge, because Jared will often want to rise to the role of dictator.

Last weekend was tough. A good family friend lost his Dad, and it was important to me that we all attend the visitation. Everyone looked sharp, we practiced our condolence sentiments, Thomas didn’t even complain about his button down shirt, as we let him where his Superman t-shirt underneath. Our plan: get in and get out. I’m sure you’re all familiar with this tactic, only this time, Jared wanted to linger. I can feel my blood pressure start to rise, but what could be the harm right? All the possibilities are flooding my brain – how long will it take for Jared to become aware of the really cool accoustics in the room? Will he get too interested in the open coffin? Redirection is not working – and is being met with louder and louder “No’s”. Jared is digging in his heels, and we have to bodily remove him from the church. I won’t lie, this stuff shatters me, and what makes it harder is that it doesn’t seem to rattle Jared. He gave an unsolicited apology to our family friend, which was wonderful and shows his empathy, but bupkis for Mommy. This may come off as pure pettiness, but routinely hiding bruises from my child has taken it’s toll. I refuse to believe that I am unique here, and as hard as it is to write about, I wonder how other moms might deal with this issue.

On the other hand, happy holidays and don’t let me bum any of you out. Lisa

— added by Anonymous on Thursday, December 18, 2008 at 12:39 pm

Thank you for the explanation. I think, however, that I disagree with the underlying principals. I think it is just too simplistic, and at the same time, far too complicated for parents to follow this. There should be more intuition, more natural living in a family’s life; well, most families, I guess, not all. It depends on your family style and goals. It depends on each individual’s needs. I do not believe that inconsistency is worse than doing nothing. Inconsistency can teach any child how to be flexible, how to learn how to adapt to change, which is the way life really is. Inconsistency in a gentle, loving family is perhaps the kindest way to teach this skill.

I have also heard from autistic adults who can express themselves via email and from what they say, many of them feel that ABA taken to extremes is simply damaging.

I maintain that humane ABA (ABA coupled with kindness and empathy and a teacher with good instincts and good observation skills) has its place in the classroom and even home somewhat for certain straightforward skill-building. But it fails on so many other levels that parents and educators ought to be prepared to try other things, including observing the child carefully to get to know why things might not be “working.”

— added by Susan Senator on Thursday, December 18, 2008 at 1:00 pm

Any good, ethical ABA provider is “humane” so not sure what you mean by that. The research shows inconsistency just leads to behaviors so I have to disagree with you there. I think to say it is too difficult for parents… well, that depends on the parents. I know many parents who have become experts themselves and are better and more effective than an ABA provider out there.

I always find it unfortunate that people equate good, consistent ABA with not being “loving.” Actually, providing rules, boundaries and limitations through good ABA to an autistic child IS being a loving effective parent. I think too often parents just think they can treat an autistic child in the same manner as a typical child and get the same results. Wish it were that easy but it is not and it has nothing do to with being inhumane. Quite the opposite. I think it is inhumane not to give the child effective support at all times.

— added by Anonymous on Thursday, December 18, 2008 at 1:22 pm

Neither of my twins seems very interested in routines or schedules. They like what they like, but so far it doesn’t need to happen in any particular order.

Of course, everyone tells me otherwise, but luckily all those everyones don’t actually live at our house!

— added by Mom to JBG on Thursday, December 18, 2008 at 3:34 pm

My son is older and has never experienced ABA. I feel fortunate that we’ve managed to escape it. For him, a positive attitude exhibited by those he comes in contact with, preserves his self-esteem, and promotes well being. He is severe, but maintains a job and lives in the community. This concept is very simple, but requires a caring, qualified support system. We can learn so much from our kids and their behavior, we just need to pay attention. It is often their primary means of communication.

— added by Anonymous on Friday, December 19, 2008 at 12:07 am