Just Carry The Tray

Today's blog was written by our very own Clinical Director, Dr. Barbara Kaminski, Ph.D, BCBA-D. If you enjoy today's blog and are in the Northern Virginia area, sign up for our free Autism Awareness Workshop, Saturday Dec 17 from 12-2pm for more insight into how parents of children on the Autism spectrum navigate the world:http://www.signupgenius.com/go/409094aa8ab2ea4fb6-autism 

So, I have had the idea for this blog bouncing around in my head for months. To be honest, I was struggling with how to write about this without sounding judgmental. That’s especially important because what I wanted to write about was, well, not being judgmental. It all started when I heard a story about the reaction of an onlooker when a child with autism had a meltdown in a public place. The story is paraphrased below, but you can read it in its entirety at the From the Bowels of Motherhood blog site (http://fromthebowelsofmotherhood.blogspot.com/2014/03/the-good-bad-and-unknown.html?m=1).*

The scene: a busy fast food restaurant at lunch time. A mom with three young children, the middle child a 2-year old diagnosed with autism. Despite a long wait for the food, lunch was going well until there was an unexpected change. A juice box that was shaped differently than the ones at home. A meltdown ensues. Mom gathers things together to leave. On one arm, baby in car carrier, trying to also manage meltdown child. The other hand carrying a food tray full of trash. An older woman approaches from a nearby table. Glimmer of hope. Surely she will offer to take the precariously carried tray. Instead of helping, she simply comments, “Wow, you have a pretty unhappy little boy on your hands there. He must need a nap.”

Every child has their meltdown times. For parents of typically developing kids, there are some basic things that you can do. Avoid running errands right before nap time. Make sure the kids have eaten before going to the grocery store. Knowing those things help, but things will never be perfect. As a parent, I have my own stories of meltdowns in public places.

But for kids with special needs, the things that trigger meltdowns are not always so avoidable. Or predictable. In the story above, the meltdown happened because the juice box served with the kid’s meal was a slightly different size/shape than the one served at home.

ABA practitioners who work with kids with special and behavioral needs often work on skills that in cognitive behavioral therapy are called “theory of mind” skills. A critical “theory of mind” skill is perspective taking, which refers to the ability to relate to others, make reasonable inferences about someone’s thoughts, feelings, and motivations, and make predictions about their needs and reactions. An onlooker’s reaction can relate back to this skill. It’s not that many people don’t have theory of mind skills, it is that they don’t have the experience and frame of reference to take the perspective of a parent of a child with special needs. Most people have experience with kids melting down because they are tired or hungry or “spoiled brats.” If you have never had experience with a kid who melts down because of a “wrong” shaped juice box, it is very difficult to include that in your perspective taking. If your experience is that kids melt down when they are tired, then that is the most likely way you will interpret the situation in front of you.

Perspective taking can help an onlooker to be sensitive to the fact that parents of children with autism may be experiencing additional stress. That said, in a situation like the one described, an onlooker doesn’t necessarily need to take the perspective of a parent of a child with autism, just the perspective of another person in a challenging situation.

So, what can be done in these kinds of situations?

If you are the parent:

·         -Try to keep your cool.

·        - Remember, people may have difficulty taking your perspective and so they may not respond to the situation in the most helpful way.

·        - It won’t always be possible, of course, but when it is, educate.

·         -Be sure to educate both those who respond poorly and those you step up and are helpful. -Just because someone is kind, doesn’t mean that they wouldn’t benefit from learning more.

If you are the onlooker:

·        - Don’t judge

·        - Offer to help as appropriate. Some parents may not appreciate the offer. Because it is a time of high stress, the parent may even respond rudely. That’s okay. You were the better person for offering.

·        - Most parents, regardless of whether the child has special needs, will appreciate the offer.

Bottom line is: offer to carry the tray.

*excerpt shared with permission of the original author

Things To Know As An ABA Therapist

Today's Blog was written by Green Box ABA Owner and CEO, Carl Dzyak M.Ed LBA, BCBA 

Working in ABA can be an extremely rewarding career.  You are able to make meaningful change on a regular basis and every day is different!  However, being new to the field can be a little scary because there are so many things to consider.  Many ABAtherapists work in their clients’ homes, which can make things tricky as ABA therapy generally occurs multiple times a week and can last several hours in length.  That’s a lot of time to spend in someone else’s house!  Every client is different, and every client has different rules and expectation within their home.  Below are some easy questions to ask new clients right off the bat to ensure you can avoid as many awkward situations as possible:

1) Ask if you should take off your shoes.  This may seem like a simple idea, but when you are standing in a client’s doorway you are still making a first impression.  Some clients feel very strongly about their no-shoe policy.  Use this as an opportunity to show social awareness and professionalism right from the onset. Doing so will convey that while you cannot avoid being in their personal space, you will absolutely respect the rules of it.

2) Ask which rooms are available during therapy sessions.  Since most ABA companies are adopting natural environment teaching, this means that the sessions could potentially migrate throughout the house.  Finding out early communicates that you understand the necessity of professional boundaries.

3) Ask about the rules for snacks.  You may not be using edibles as reinforcement during your therapy, but the session may be occurring during a snack time.  Some kiddos will ask for snacks from their therapists knowing that they are not supposed to.  You do not want to be the therapist who is found digging through the family refrigerator who then has to explain that they were basically tricked by the student.  Some families will want you to help grab the snack and some families will want to get it themselves.  Being mindful of this will once again help you avoid an uncomfortable situation.

4) Ask about general house rules.  Once again, every family is different.  It’s impossible to predict all of the different idiosyncrasies at the very beginning of a professional relationship.  These idiosyncrasies may range from expected manners, to language, to rules about pets.  If you have a hard time remembering the different rules for all of your clients, make sure to write yourself a note.

The purpose of this blog entry is not to scare new therapists, but rather to prepare them for success.  In most cases clients are thrilled to have you there and are not excessively rigid with their rules.  However, by knowing what to ask and what to look for, you can avoid any avoidable hiccups that could potentially set a therapy relationship back.  As you gain experience working with different families, you will start to gain confidence by learning to read the different cues and adjusting accordingly.  If you remember to be polite, respectful, and ask the right questions you will be off to the right start for any therapeutic relationship.

Do You Like The Beach?

Today's blog was written by Dr. Barbara Kaminski, Ph.D, BCBA, who is the Clinical Director for Green Box ABA, PLLC

I was just standing in the surf, letting my feet get buried deeper and deeper into the sand with each wave. He appeared seemingly out of nowhere and was suddenly standing between me and the next wave. “Do you like the beach?” was his first question. I paused. The manner of his approach and the rhythm of his speech were definitely cues that this man was on the autism spectrum. I responded with a statement and then a reciprocal question. He “sort of” answered the question and then asked me another question. Peer response. Peer response. He finished by extending two fists with “thumbs up.” I looked at his extended fists, wondering what the response should be; what had been used as the “social reinforcer.” I gave him a double fist-bump. He looked disappointed and left his fists in place. Wiggled his thumbs. Ah, okay. Another “fist-bump” but this time we touched thumbs. He happily ran off into the waves. I didn’t actually take the time to count, but in retrospect, I think we had about a 10-exchange “conversation.”

Out of everyone on the beach, he chose to approach me. It was a good choice and I am thankful. Given my profession, I had some idea of how to respond to him in a meaningful way. On the whole, both the initiation and the conversation had the formal appearance of being appropriate. But even to me it felt unnatural and, well, kind of odd. And who knows how many other people he had “initiated a conversation” with on the beach and how they responded. I am sure some were polite and tried to have a conversation. I can imagine others who were not so polite, if you get my drift.

I have no doubt that he has worked very hard on these social skills. I have no idea whether he worked on them formally with an ABA provider. At the very least, he probably had social skills goals on his IEP. But there was definitely something missing.  To me, things just felt out of place. To someone without my experience, I am sure it would have felt uncomfortable. As a professional who frequently works on helping kids on the spectrum learn social skills, I felt convicted. Do we often stop short of teaching truly functional, meaningful social skills?

It is daunting, to be fair. In our social interactions, we make highly conditional discriminations, in a fluid, ongoing way. If we take the time to “process” what to do next, our social interaction becomes stilted. At the very least, our discriminations are on based on the conversational partner (is this a friend, an acquaintance, a clerk at the store, a supervisor/teacher, etc.) and the context/setting. There are scenarios where we might have a successful initiation with an unfamiliar person at the beach. For example, if I have a boogie board, I might talk to someone else with a boogie board about the height of the waves. Or if I notice that someone has built a super amazing sand castle, I might ask her a question about that (“That’s an amazing sand castle. How long did it take you to build it?”). However, no matter how much I want to know more about the sand castle, I may not initiate a conversation with her if she gives cues that she needs to chase after a toddler on the sand. I will admit that the sheer number and variety of contextual and social stimuli that function as discriminative stimuli for emitting (or not emitting) a social behavior can make this next level training seem nothing short of impossible. But as behavior analysts, we have the training and the skill to break it down into manageable, albeit complex, targets.

I would never suggest that we shouldn’t work on the basic building blocks of the social skills repertoire – initiating conversations, asking questions, etc. I spend a lot of time teaching the topography of the behavior – “how” to initiate a conversation, for example. But personally, I often don’t get as far as helping clients learn “when” to initiate a conversation. Or how to end a conversation naturally. And if I really want my clients to not just interact with others but to actually develop relationships, then I need to help them work on those sorts of things too. Unless what I want is a client who in the future has awkward conversations with random women on the beach, that is.

Inspiring a Passion

Today's blog was written by Steven Perkins, M.Ed., BCBA, LBA, who is one of the ABA Program Consultants at Green Box ABA PLLC

I loved theatre growing up and started joining Saturday morning theatre groups at a very young age.  We learned to sing, dance, and act; I felt so at home on the stage. I was convinced that theatre would be my future—my career. I would perform songs at family reunions, make home movies with neighborhood kids, and act in every school play. Right before 4^th grade, we moved to a different neighborhood, and I had to switch schools. There, I met a boy named Chris. Chris inspired me in so many ways, including helping me see where I wanted to direct my life down the road.
            Chris was a boy my age with Down’s Syndrome who lived down the street from our new house. When we met, he didn’t have a lot of friends and since I had just moved, I didn’t know anyone. We started to do fun activities together like sleepovers, spending days at the pool, and going to the movies. Looking back, Chris had good communication skills and some age appropriate interests. We were similar in that our age appropriate interests and ability to interact with our peer group were more limited than others. We spent a majority of our time just the two of us.
             By the time middle school came around, Chris and I had become best friends. In 6^th grade, more opportunities opened up as kids gained independence and could begin choosing electives or sports teams.  Chris and I were nervous to branch out, but our parents encouraged us to join more activities with our peers. I wanted to do choir as my school elective, and Chris wanted to join Boy Scouts for an after school activity. We each agreed to join both to go through them together.
            It was during these middle school years that I realized my passion for helping individuals with disabilities. I never saw Chris as “that kid” in our class that looked and acted a little different; I saw him as my best friend. I saw him as someone I could open up to and count on. I saw him as my equal, or even more so, I looked up to him.
            In middle school, I helped the guidance counselor set up the “lunch buddies” club where Chris chose a few friends and we would all have lunch in her office once a week. Most other days, Chris and I sat by ourselves in the cafeteria. In Boy Scouts, we were nervous to go on a week long camping trip, but then I won “Scout of the Summer” at the closing ceremony. The camp applauded me for being one of the only scouts to consistently help Chris with activities that were harder for him.
           My family moved again when I was 15, so Chris and I went to different high schools. We unfortunately lost touch over time, but his mom kept me up to date about life milestones like his first girlfriend, earning his Eagle Scout merit senior year, and moving away to attend college at Old Dominion University. He sent me a friend request on Facebook a few years ago and he will post the occasional picture, primarily of he and his current long-term girlfriend.
           I continued to do theatre productions throughout high school and even double majored in Theatre and Psychology in college, but gradually continued to shift my focus to special education. I have now worked in both private and public schools and am currently employed as a Board Certified Behavior Analyst for a company that provides Applied Behavior Analysis services. Perhaps this was always my path, but I believe that Chris helped shape my future and provided me with the passion to help other individuals with disabilities.
          Looking back, I am certain my friendship with Chris strengthened many skills that I use on a daily basis in my profession. Chris helped teach me patience, kindness, perseverance, gratitude, compassion and ambition. No matter where life takes each of us, Chris’s impact on my life and passion will last forever. He helped teach me to strive for what may seem unreachable, to be proud of every accomplishment, and that everyone should be treated equally.

What is Task Analysis?

Have you ever thought about how many little steps go into things you do every day? This morning I brushed my teeth, braided my hair, and made coffee. The amount of smaller steps that go into each of those tasks is astounding. If I had written down every single action I took to brush my teeth or braid my hair, I would have written a task analysis for myself that I could then use to teach someone else how to brush their teeth or braid their hair. For kids on the autism spectrum who may have difficulties with processing or executive function, tasks that seem simple to us like brushing teeth can be overwhelming. Breaking those tasks down into component steps, much like you might make a to-do list for a multi-part project, can be a huge help for kids struggling with both social and non-social situations.

Part of an example of task analysis for tooth brushing. As you can see, it breaks brushing teeth down into tiny, manageable parts

         A task analysis breaks a complex task like brushing teeth or greeting a peer down into its most basic steps. Task analyses are completed because there are a variety of steps that go into completing a complex task, and to teach that task you need to know that your learner can complete each step. Additionally, some tasks need to be completed in order; for example, brushing your teeth with a dry toothbrush then squeezing toothpaste onto that toothbrush doesn’t work. This is also valuable because you can reinforce each step as you teach it in a process called chaining, which can be done forward or backward. In forward chaining, you start by teaching the first of the steps you wrote down in your task analysis. This can be useful if your learner already has some or most of the requisite skills needed to complete the task. For instance, if tying shoes is your task and your learner can already put their feet in the shoes and grab the shoelaces, forward chaining might be the way to go. Backward chaining starts by teaching and reinforcing the very last step of a task, then the penultimate step, and so on. This can be good because you’re always reinforcing the final outcome of the task, so no matter what step you’re currently teaching, your learner is always completing the task independently. Breaking down your task and teaching through chaining allows for greater access to reinforcement throughout the teaching process, which can be especially useful in social situations, For more information on reinforcement in social situations, look out for our upcoming post. The degree to which you simplify the steps depends on your learner. For example, if the task is “washing hands” some learners will need “turn on water, put on soap, scrub, turn off water,” while others will need a more detailed list. Sometimes pictures can also be helpful in teaching each step, like adding a picture of your learner’s toothbrush and faucet handle to their list of steps. Knowing what will be most helpful to your learner is crucial to making a useful task analysis.

Task analyses can also be completed for social skills group. First, a social skills assessment needs to be done. Things like ABLLS and VBMAPP as administered by a professional behavior analyst can be used to assess the learner’s social skills. Once you’ve selected a goal, then you can break it down. For example, we find that during issues of dispute, one of our learners typically tantrums rather than selecting a compromise for a solution. Now we have our goal and it’s time to break it down. Refer back to the hand washing example-the component steps will be based on the learner’s needs. An example of component steps for compromise would be identifying functional compromise solutions when presented with a social dilemma with a peer. In order to identify those solutions and break that process down into steps, keep in your learner’s goals and program targets. For more information on setting goals for social group, refer back to our blog post here. One example of a situation where a social task analysis for compromise might be useful might be a social skills group science project. All of the learners in the group need to compromise on the topic of the science project, which means no one is going to get to do exactly what they want to do. Luckily, since this hypothetical science project takes place in a social skills group, each kid can have a task analysis done for compromise with adults helping to facilitate the interactions and prompt the different steps of the task analysis. Once the learners have practiced using their task analysis during a contrived situation like social skills group, they can generalize to natural situations like hanging out with friends or working on a project in class, fading out adult prompting to boost independent social interactions.

Task analysis is important because while some tasks might seem second nature to neurotypical people, they can be daunting for people on the autism spectrum. Interacting with other people, even before morning coffee, is simple for neurotypical people because we know the various steps that apply to each social situation, and it can be difficult to try to explain those steps to someone else. Task analyses break these social situations down into the steps we already go through and make them accessible to people on the autism spectrum instead of just expecting them to do the things their typical peers do. We all make task analyses for ourselves, we just usually call them to-do lists or have tasks mentally broken down in our heads. Task analyses are just versions of these lists, modified to best help our learners navigate the world.

Product Spotlight- Green Box Kids Book 1: Sharing

Sharing is one of the most important skills we try to teach our students, and it’s something they’re going to need to use every day for the rest of their lives. Even as adults, sharing is something we do all the time, so much so that it’s jarring when someone doesn’t share; how many times have you waited for a machine at the gym or an electrical outlet at a coffee shop and been absolutely bewildered when the other person using them failed to share? We know sharing is tough for all kids, and it can be even more difficult to help kids with behavioral and developmental disabilities understand all of the various social elements that comprise good sharing. We’ve created another social skills training curriculum book to address those very difficulties in a format that is both fun and engaging for both you and your learners. We’ve talked at length about another book in the Green Box Kids series, Compromise, and we’ve brought the same commitment to excellence and accessibility to Sharing, now available on Teachers Pay Teachers.

Sharing has the same format as Compromise: discussion questions before and after each of the three comics in the book to boost critical thinking about the topic, plus supplemental activities that expand upon those questions. In addition to fostering discussion about the basics of sharing, this book goes into situations when sharing may not be appropriate by asking learners questions like these:

Our focus here is not just to help learners understand what sharing is, but why sharing is important to their lives. What makes Green Box Kids: Sharing different from other curriculum books on Sharing is that it encourages learners to examine sharing from multiple perspectives. Additionally, although each social dilemma presented in the comics has an example of a resolution, the book also encourages the readers to think of their own solutions. For example, the first comic in the book sees Tito and Lucy playing an active game of soccer, but Tito has forgotten his water bottle. Before showing the readers what the Green Box Kids do to fix the problem, there’s an opportunity for the reader to draw what they think would be a good way to help Tito:

Instead of just telling readers what the best answer is, this book encourages them to think for themselves and consider the options their peers came up with.

Our social skills training curriculum books are more than just social group activities, they’re the building blocks of happy, sociable adults. When you buy our book on Sharing, you’re getting comics along with improved social skills and better, more productive social group sessions. As with all of our books, the material in Green Box Kids: Sharing are the product of years of working with kids who have autism spectrum disorders and other behavioral or developmental disorders, as well as years of training and education. More importantly, when you buy our books you’re buying the product of our sincere desire for kids on the spectrum to have a better quality of life and an easier time adjusting to social situations outside of supervised social group. Our kids love Green Box Kids, and we’re confident that yours will too.

Setting Goals for Social Skills Group

We’ve talked before about why individualizing goals for the kids in your group is important, but what exactly does it mean to set a goal?  Every goal should have a sheet with the current target, the purpose of the program, the procedures of implementing the program, how to collect data on the target, and what constitutes as mastery. Here’s a basic rundown of the elements that go into setting goals for autism spectrum kids in a social skills play group:

Purpose

n  Why are you setting this particular goal? Which behaviors are you looking to increase or decrease? When setting goals, think about whether or not those goals will improve the individual’s life. If the answer is no, it’s not a good goal to set. We’re always looking for social validity, so for example: your 5 year old student keeps making jokes about poop. You think poop jokes are gross, but you wouldn’t necessarily want to write a program to decrease the jokes, because that’s typical behavior for a 5 year old, and other typical students are also making similar jokes. We’re not looking for cookie-cutter perfect kids, we’re helping kids interact with other kids in socially acceptable ways. Knowing which skills your kids are working on and why they’re working on them is important for understanding how best to implement the program’s procedures. Often times the social skills group goals set for your kids will be related to goals set for one-on-one therapy sessions. For instance, let’s say a student’s home therapist is working on increasing wh- questions. The same program may be tweaked to fit social group by asking peers to ask the student wh- during group to track generalization.

Procedures for Implementation

n  What steps go into this goal? For instance, if you’re working on a tacting program (labelling objects and people based on visual cues) using picture cards, your procedure might look like this:

                                                                                                 i.    Take out picture card

                                                                                                ii.    Hold up picture card of preferred item

                                                                                              iii.    If child responds appropriately, put a correct trial mark in trial box. If child responds inappropriately or does not respond, give correct answer and return to step two.

That’s just one example, and procedures can (and almost always will) have many more steps than that. Knowing your procedure is important because following the same procedure across different environments and therapists, teachers, parents, and caregivers is the only way to get reliable and accurate data across the board. This is especially important to note when individualizing goals for social group, as we’ve discussed here. Here’s what an example procedure might look like:

As you can see, it’s specific and doesn’t leave room for too much interpretation, which is important. Everyone implementing the program should be able to quickly read and understand the procedures to keep them consistent.

Collecting Data

n  There’s an entire post on collecting data during social group here, but the basics of it are as follows. You’ll most likely have a few group-appropriate goals to focus on with a description of their procedures, and then a row of small square boxes in which to mark whether the target behavior was completed or not, with each box representing one trial. If a correct trial occurred, you would record a +. If a prompted trial occurred, you would mark a P. This is called trial-by-trial data collection, and it’s what’s most often used during social skills groups with anecdotal data (general notes) kept as well. Keeping accurate, consistent data is important for several reasons, but above all data will tell you when a target has been mastered so you can move on to the next target.

Mastery criteria

n  The idea behind mastery criteria is to set a level of performance that lets the instructor know the student is ready for the difficult of the target to increase. Mastery should be a certain percentage above the child’s current performance. Mastery criteria are set somewhere between 80% and 100% correct performance across multiple sessions or days. The high level of accuracy is included because the skill must be established before moving on to the next target. Including a time component or multiple session component to the mastery ensures that phenomenal performance on a given day is not a fluke.

Targets

n  Finally we have targets, which are different levels of program mastery. Many programs will have similar procedures for several targets. For example, let’s say that Barry’s target is 1 peer response (responding when a friend asks a question or says hello) with one prompt, with the program purpose being increased intraverbals. Once he’s mastered that target, his next target in this program might be 1 peer response with no prompts. Targets build off of each other to increase or decrease the target behavior. In the ABA world this is known as shaping, which we’ll talk about more in a later blog. All of these elements put together form a solid program that can be used to make social group a better, more efficient process!