Submitted by: Lindsey Knopf, BCBA

Resurgence has not been a term that has been frequently used in ABA, but it is very important because it occurs frequently. Resurgence describes the recurrence of a previously reinforced behavior following the extinction of the subsequently reinforced alternative behavior. This means that an appropriate behavior that used to be reinforced is no longer getting any reinforcement (i.e. it is being put on extinction).

For example, a problem behavior such as whining used to get a child access to something preferred, such as candy. But then the child is taught to ask appropriately for what he or she wants by saying “candy” without whining. Asking for candy appropriately now always gets the child candy, rather than the whining. However, in school the candy is not always available and when asking appropriately is no longer reinforced frequently enough, problem behaviors such as whining will come back again or reoccur given that these behaviors have gotten the child candy in the past.

Here is another example of resurgence and how it can be broken down into 3 phases:

• Phase 1: A problem behavior is reinforced (e.g. shouting out an answer in class always gets attention from the teacher).
• Phase 2: An alternate behavior is reinforced while the target behavior is put on extinction (e.g. raising hand is given attention and shouting out the answer is ignored).
• Phase 3: The alternate behavior is not reinforced as often so the problem behavior begins to RESURGE or reoccur given its reinforcement history (e.g. raising hand is no longer reinforced every time due to a substitute teacher who does not know to call on the student who is now raising his/her hand instead of shouting/other kids are getting called on so the child shouts out the answer since this behavior has gotten attention in the past).

This concept is important because when placing problem behavior on extinction (i.e. no longer allowing the behavior to contact reinforcement) and teaching replacement/alternate behaviors, we need to make sure that we continue to reinforce the replacement behavior so that the problem behavior does not reoccur. A fixed time schedule of reinforcement refers to when a fixed amount of time is required to earn a reinforcer (e.g. providing reinforcement every minute that problem behavior does not occur). Using a fixed time schedule of reinforcement can also help maintain the alternate/appropriate behavior. This shows the child that he or she does not need to engage in the problem behavior to access reinforcement.

When teaching an alternate behavior, we need to start with a dense schedule of reinforcement (e.g. providing reinforcement every time the behavior occurs) and then gradually fade the schedule (e.g. providing reinforcement every other time the behavior occurs, then about every few times the behavior occurs, then about every 5 times, etc.) to the point where it is manageable for caregivers to provide reinforcement in the natural environment. The fact that the child can perform the alternative behavior does not necessarily indicate that natural occurring schedules of reinforcement will maintain it. We should let all treatment team members and caregivers know what behavior(s) we are placing on extinction and what behavior(s) we are reinforcing. Our goal is to reduce problem behavior and increase appropriate behaviors, so it is very important to be aware of resurgence and actively prevent it from occurring.

Talk to your child’s ABA instructor about the function of your child’s problem behavior and the replacement behaviors that are being worked on. Work on increasing and maintaining replacement behaviors by:

• Having the ABA instructor come into your home or community setting to model how to reinforce the replacement behavior and place the problem behavior (s) on extinction.
• Asking for more center-based parent training.
• Providing extra reinforcement for more independent responding (differential reinforcement).
• Providing reinforcement immediately after your child engages in the replacement behavior (between 0-5 seconds).
• Providing reinforcement that serves the same function as the problem behavior (allowing escape or a break from a difficult or aversive task, providing attention to the child, giving the child access to a preferred item or activity, or allowing the child to engage in a sensory activity).
• Providing reinforcement every time the replacement behavior occurs, then gradually fading reinforcement for the replacement behavior.
• Making sure problem behavior never contacts reinforcement.
• Reinforcing the absence of problem behavior.

The post Resurgence: Problem Behavior Occurs When Appropriate Behavior Was Taught appeared first on Reaching Milestones.

By: Nicole Williams

Summer is right around the corner and the east coast is preparing for days at the beach, vacations, barbeques, and plenty of fun in the sun. While summer can provide families with an opportunity for fun and a much needed break from the daily grind of school and work, this season also includes unique challenges. For a child with ASD, inconsistent schedules, high temperatures, and visits to new places can be especially difficult.  However, with a little preparation, parents and their children can enjoy the summer sun and breeze through the heat. Below are a few key tips to help ease the transition into summer.

1. Maintain routines: During the school year, a child wakes up at a reliable time, goes to school (where they follow a schedule of daily activities), completes his homework, eats dinner, and finally finishes up the day with his regular bedtime routine. These routines fill much of your child’s time. Though your child may not be in school, maintaining daily routines will ease the transition into summer and be especially important when it is time to go back to school. Even adults may find it difficult to adjust from having a busy, filled schedule, to having an excess of free time. Routines such as chores, outside time, and bedtime can be kept throughout summer while still allowing for your child to enjoy their break from school.There are also plenty of activities to schedule throughout the summer to keep your child engaged and from becoming sedentary. For example, summer camps, sensory screenings at local theaters, and swim classes are great options. Feel free to ask your local Reaching Milestones’ office for more ideas.
2. Be Proactive: When temperatures rise, even the best of us can find it difficult to be patient. Those of us in Florida and Georgia are all too familiar with the sticky and gross feeling that comes with being outdoors in the middle of July. While we may be able to recognize the need to go inside to cool off or to drink some ice water, your children may struggle to communicate this need. It’s important to watch your child for signs that they may be getting too warm and to make sure they stay hydrated. If you notice that your child is sweating and looking a little red from the sun, we recommend providing them a prompt to ask to cool off indoors or for some water. Other ways to stay prepared include having summer necessities on hand, such as water, sun screen, bug spray, and plenty of snacks. Not only will being proactive decrease chances that your child will engage in inappropriate behaviors because they are uncomfortable, but it can also keep them safe from summer dangers, such as heat exhaustion.
3. Vacations: Trips to Disney World, Grandma and Grandpa’s house, or even just a weekend getaway to the beach can be a lot of fun, but it can be overwhelming for some children. Airports and theme parks are busy and crowded places. If your child has a history of being sensitive to loud noises, bringing ear plugs or head phones could set your trip up for success. Providing a tentative schedule of events for your trip can also be helpful for some children. Though it may be more difficult on vacation, keeping some of your child’s routine intact can help tremendously, such as naptime or bedtime. Another way to prepare for long trips is to prepare a travel bag for your child when they are in the car or on a plane. Fill this bag with coloring kits, books, small toys, snacks and other portable items to help keep your child engaged in appropriate behaviors.

By following these tips and preparing ahead of time, you and your family can make the best of summer. Most importantly, remember to enjoy any extra time you can spend with your family, take lots of pictures and make memories to last a lifetime. If you have any questions or specific concerns about summer and your child, please ask your therapists at Reaching Milestones. Now get ready for some fun in the sun!

The post Preparing a child with autism for summer vacation appeared first on Reaching Milestones.

Health Insurance Coverage for Autism Services Varies By State

These laws vary by state. Some give monetary caps on a yearly or lifetime basis on how much can be spent on an individual child. Some allow for more money to be spent on a younger child than an older child. Some insist that the diagnosis be made by age 8 in order to have health insurance cover treatment for autism. There is room for improvement in many states, but the toughest battle is fought by children with autism and their parents in states where coverage is not yet required. Mississippi is one of these states, but there are currently two bills that are being considered that, if passed, would require health insurers in the state to cover screening, diagnosis, and treatment of autism from birth up to age 21.

Mississippi’s Recent Push For Autism Health Insurance Coverage

Mississippi has seen similar bills in the past, and so far has failed to pass an insurance mandate for autism diagnosis and treatment. The difference this time may lie with one on the co-authors of the bills, Mississippi Secretary of State Delbert Hosemann, whose 3 year old grandson has autism. There has also been a strong push from autism advocacy organizations, such as Autism Speaks. It is estimated that there are at least 10,000 children with autism in the state.

If the bills became law, health insurers in Mississippi would be required to cover screening, diagnosis and treatment of autism from birth to 21 years. The bills ask for coverage that includes psychiatric, psychological, and pharmaceutical care. It also asks that children be covered for up to 25 hours a week of Applied Behavior Analysis (ABA), a treatment method that has been beneficial to many children with autism and has played a big role on their ability to succeed as an adult later on.

In addition to providing care and services for children with autism, the Mississippi bills also include some over site in an attempt to prevent that services from being misused. They call for the creation of a Mississippi Autism Board that would be responsible for issuing and revoking licenses for Applied Behavior Analysis. They would be responsible for checking for violations and setting professional regulations.

Getting Help Without Insurance Isn’t Easy

Many parents who have a child with autism have found a way to get their child the treatment they need, even without insurance, but doing so makes life more difficult for the entire family. Working an extra job has not been unusual for some parents, but that extra time at work strips these parents of valuable time with their families.

Worth The Investment

While Mississippi lawmakers may be concerned about the cost of providing health insurance coverage for children with autism, in the long run the investment would likely save the state money. Dr. Keith Radley, Assistant Professor at the University of Southern Mississippi in Hattiesburg, MS, pointed out a 2007 study done by Chasson, Harris and Neely in Texas. Estimates for Texas indicated a savings of $208,500 per child with Autism throughout 18 years of education, if behavioral interventions were implemented early in the child’s life.

Conservative estimates in Mississippi look at approximately 4500 children with ASD in the state, and combines this data with information from National Association of Child Care Resource and Referral Agencies (NACCRRA) and statistics from the Center for Disease Control (CDC) to estimate a savings of more than $935 million just by mandating that early intensive behavioral interventions be covered by health insurance. Besides the financial savings, parents and experts advocate the treatment, noting the positive impact it can make in a child’s life, as it makes a child more employable, and can lead them to a college and career opportunities

The post New Bills in Mississippi Senate Call For Insurance Coverage for Autism appeared first on Reaching Milestones.

But while a child without Asperger’s might be signed up for soccer or basketball and love it, it’s less likely that these activities will be a good fit, since they are both highly sensory and difficult for kids with Asperger’s or who fall somewhere else on the Autistic Spectrum to handle. There are, however, several possibilities that can bring out the skills of a child with Asperger’s.

Athletics

Sports that involve a lot of contact or demand that a child be in close proximity to others are usually not ideal, but exercise is important for any child, or adult. For those with Asperger’s, it is easier to thrive in sports that allows them to develop some athleticism, while still allowing them a sense of personal space. Tennis, track, or even gymnastic teams are all possible choices. While there is ultimately a team component, the actual sport involves only a few people, and in many cases is something that is actually practiced independently. Team performance is calculated mathematically, and many kids with Asperger’s can appreciate having this type of order in their activity.

Asperger’s Meet Up Groups/ Play Groups

If your child is undergoing treatment for their Asperger’s syndrome, it may give you an opportunity to meet other parents whose children are going through experiences similar to their child. Since children with Asperger’s develop an intense interest in specific things, two children with a similar interest might get along especially well.

Special Interest and Academic Clubs

Depending on the club, special interest and academic clubs may or may not have a competitive element to them, but children with Asperger’s can benefit from being involved with them. In either case, exactly what club is chosen should be dictated by the child’s interests. For example, if they like to take things apart, a robotics club may be enjoyable. Those who are very strategic might want to join a chess club. Astrology and Math clubs are also options that might be a good fit for some children with Asperger’s.

Private Lessons

While it can be good for a child with Asperger’s to develop their skills and interests along with other children their age, not every child will be ready for that much socialization. For these kids, developing talents by taking private lessons is a good choice. Many children with Asperger’s develop strong interests and talents in areas such as art, music, or photography. Some have a very good report with animals, so something such as horseback riding lessons might be beneficial. Private lessons will give the child an opportunity to connect with their teacher and develop their interests as deeply as they wish. For some, skills nurtured by private lessons may even lead to employment later in life.

However you choose to go about helping a child with Asperger’s get involved with an extra-curricular activity, it’s important to let them set the pace and that they are given a say in the type of activity they are going to participate in. That way the activity can truly enhance the child’s life.

The post Guiding Kids With Asperger’s Syndrome Toward Extra-Curricular Activities appeared first on Reaching Milestones.

So, while the general public seems well aware of the prevalence of autism, I’ve been surprised to find that many people I come in contact with aren’t aware that effective treatment for autism even exists.

One of the most effective treatments available is known as Applied Behavior Analysis (ABA). ABA has been endorsed as an effective treatment for ASD by the U.S. Surgeon General and the New York State Department of Health as well as a number of other state and federal agencies. In a nutshell; ABA is research base individualized treatment. The efficacy of this method of treatment is supported by over 25 years of research. Its application involves one to one instruction in programs based on the functions of behavior.

The research shows that children with an autism spectrum disorder diagnosis can benefit tremendously from ABA services, especially those who are diagnosed early and receive 25 to 30 hours of ABA per week. In many cases, children who receive early intervention are able to enter kindergarten and/or first grade in a mainstream classroom with no additional assistance needed!

So, we have this treatment, it is proven effective, why aren’t parents aware that it exists and why aren’t children receiving the service? The simple answer: is it’s not covered by their insurance provider!

Why on earth would health insurance companies deny coverage for an effective treatment for a disorder of such magnitude? Another simple answer: they’re not required to.

Although 38 out of the 50 states in the United States of America mandate coverage for autism, the state of Georgia does not. There have been many organized efforts to pass laws that would mandate coverage, but not one has made it through both the Senate and the House of Representatives. The Governor of Georgia has said that he will sign a bill if it makes it to him. Last year, Senate passed a bill that would mandate some coverage for individuals up to age six, a big step in the right direction. However, in the House of Representatives, the bill did not get called for a vote. There is a resistance to enacting mandates when it comes to insurance reform. This is understandable, as insurance companies cannot be expected to cover everything under the sun. However, when one considers that the average cost of services required over the lifetime of an individual with untreated ASD is over $3 million dollars, compared to the average cost of early intervention services for for individuals with ASD…the savings is drastic. In its second year of implementation, South Carolina’s law mandated coverage for 371,384 individuals for $856, 369.

On January 29th, 2015 the Georgia Senate voted to pass SB1: Ava’s Law. It is now up to the House of Representatives to not only support the passing of this law, but to ask the speaker to call it to a vote.

Here’s where we come in! We as the parents, friends, and family members of the autism community have to do our part by communicating to our Representatives. Time is of the essence, we are hoping for a house hearing any day now! A good starting place can be found here: http://advocacy.autismspeaks.org/c.frKNI3PCImE/b.3932687/k.F652/Find_My_Legislators/siteapps/advocacy/search.aspx
Attach the following document to your email to provide your representative with the most important facts:

For more information on Ava’s law please visit the facebook page at:  https://www.facebook.com/avaslaw.

Together, we can make a difference.  Our 1 in 68 most certainly can’t wait.

The post The State of Autism in the State of Georgia appeared first on Reaching Milestones.

Task variation involves increasing a student’s motivation by presenting different types of instructions and also mixing new topics with those previously mastered (Dunlap et al. 1987).  Presenting unknown subjects interspersed with known material is a much more efficient and effective form of instruction (Dunlap 1984). For instance, if a student is learning multiplication facts for 8’s and has previously shown proficiency in multiplication facts for 2’s, 3’s, and 4’s, to maximize motivation and effective instruction, multiplication facts for 8’s should be presented with multiplication facts for 2’s, 3’s, and 4’s (varying difficulty), as well as mixed within reading tasks (different subjects).

Contributed by:   Rebecca Drew – St. Mary’s Clinic

The post Task Variation to Reduce Problem Behavior with Academics appeared first on Reaching Milestones.

An everyday life example of joint attention occurring could be as simple as a father and son fishing in a boat and a fish jumps and the son says, “Hey dad, look at the fish!” while looking at dad or pointing toward the ripple in the water in excitement while looking at dad waiting for his response.  The response from dad of shared excitement and confirmation that he also witnessed the event is the social reinforcement that is sure to maintain future bids for joint attention from the son.

This comes naturally for typically developing children.  For children diagnosed with autism and other developmental delays, this type of verbal behavior does not come so naturally and must be taught and paired with current known reinforcers. Ultimately children engage in this type of joint attention to share in the experience with others. For children who are not initially interested in that shared experience, we can increase this skill by using tact training.

One way to use tact training to increase motivation for shared experiences is with teaching spontaneous tacting. To start, since the shared experience does not function as a reinforcer, we have to determine an alternate form of reinforcement initially. Once you figure out your child’s motivation- a toy, edible, tickles, video, etc., present your child with a stack of books or other materials with a variety of pictures and prompt him/her to select one. From there, model pointing out objects in the books; for example, “Oh I see a boat! A boat sails in the water!” Provide more modeling and prompt your child if necessary by saying, “What do you see?” When your child responds, for instance with “A duck”; provide praise and comments such as, “That is a duck. Awesome job finding the duck. Ducks say ‘Quack, Quack’.” Continue this for a set amount of time, 3-5 minutes, and then provide the terminal reinforcer (edible, toy, tickles, etc.) at the end of the fixed time. Once your child is pointing out objects (tacting) in books or movies consistently, you can increase the response effort by waiting for your child to make eye contact when they tact an object and provide praise and comments once they look at you. Doing this often will help promote your child’s tacting and help transition the motivation from tangible objects (toy, edible, tickles, etc) to that shared experience.

Contributed by: Jeremy Cole – St. Mary’s Center

The post Spontaneous Tacting Exercises to Increase Shared Experiences appeared first on Reaching Milestones.

Senators Patty Murray of Washington and Kirsten Gillibrand of New York are sponsoring an amendment to the 2014 National Defense Authorization Act (NDAA) that will vastly improve ABA coverage under TRICARE, the military health care program.

How can you help?

CALL YOUR SENATORS:

Call: Sen. Saxby Chambliss
Phone: (202) 224-3521

Call: Sen. Johnny Isakson
Phone: (202) 224-3643

“Hello, I’m a constituent of Senator [last name] and I am asking that he vote yes for the Murray-Gillibrand TRICARE amendment to the 2014 National Defense Authorization Act improving access to ABA treatment services for military children with autism and other developmental disabilities. Our military families need access the medical care they have earned and deserve. Thank you.”

 SEND AN E-MAIL ON AUTISM SPEAKS:

http://www.autismspeaks.org/advocacy

Scroll down and click on Urge the Senate to Support Military Kids Who Need ABA! under the Take Action Head.

Complete information and send e-mail with script.

The post Vote ‘YES’ to Improve ABA Services for Military Families appeared first on Reaching Milestones.

Attention All Parents: 

Join our efforts in stopping TRICARE from restricting your child’s therapy! 

TRICARE has proposed major policies that are projected to have serious negative impacts on the therapy your child receives.  Signing petitions and voicing your concerns has worked in the past with TRICARE funding and policy changes and it can work now too!  Please find links below to all the resources regarding these changes.  You should have all received a letter and an explanation from your clinical director.  If you have any questions or further information, please share immediately with your director.  Thank you for your continued support and involvement in your child’s therapy!

Take Action Now!

Use this call/email script when contacting legislators and advocacy groups:

“I am writing/calling as your constituent to ask that you take a stand against TRICARE, as they want to limit the access to military kids with developmental disabilities to the treatments they deserve.  TRICARE is misrepresenting the BACB (Behavior Analyst Certification Board) guidelines and falsely presenting the new proposed changes as an opportunity to increase access to services. ABA (Applied Behavior Analysis) is widely accepted throughout the medical community as an effective treatment for autism and the BACB has publicly expressed their support for Board Certified Assistant Behavior Analysts to provide supervision to ABA tutors (www.bacb.com).

Not only is TRICARE making it nearly impossible to receive quality supervision of my child’s treatment, but they are also making it nearly impossible to get reauthorization for services!  Waitlists in our area for diagnosing doctors are well over six months (with some over a year), but TRICARE is requiring re-assessments every 6 months and annually!  Additionally alarming is that the tests required for these re-assessments are being used to measure my child’s progress when these tests are not even validated for that purpose!

My child makes tremendous progress with their ABA therapy and these policy changes will have a detrimental effect on my child’s treatment.  Your leadership on behalf of our military children is needed!”

Contacts:

• Step 1:  Share this information with your family, friends and support groups.

• Step 2:  Contact your local EFMP and get the answers and advocacy you deserve from this program!

• Step 3:  Contact your local government officials.

Georgia Senator – Johnny Isakson, 770-661-0999, Click here for email

Georgia Senator – Saxby Chambliss, 478-741-1417, Click here for email

Georgia Congressman – Jack Kingston, 912-265-9010, Click here for email

Georgia Congressman – John Barrow, 706-722-4494, Click here for email

Florida Senator, Jacksonville – Marco Rubio, 904-398-8586, Click here for email

Florida Senator – Bill Nelson, Click here for email

Florida Congressman – Ander Crenshaw, 904-598-0481, Click here for email

Florida Congressman – Ted Yoho, 904-276-9626, Click here for email

Contacting government officials works!  Click here to read a letter sent to TRICARE from two senators!

• Step 4:  Contact other advocacy groups.

Autism Speaks -Judith Ursitti, CPA, Director State Government Affairs, 508-785-4074 judith.ursitti@autismspeaks.org

• Step 5:  Sign this petition: Click here.

• Step 6:  Follow the Reaching Milestones Facebook page for up-to-date information:  Click here.

Information to Review:

• Letter to parents from Reaching Milestones regarding changes for active duty family members: Click here.

• Letter to parents from Reaching Milestones regarding changes for non-active duty family members: Click here.

• Acronym Glossary: Click here.

• Tricare Policy Manuals regarding changes: Click here.

• FAQ released by Tricare: Click here.

• FAQ released by Autism Speaks: Click here.

• FAQ released by Military Special Needs Network: Click here.

• New group organized to communicate and help interpret the policy changes: Click here.

The post Stop TRICARE Cutbacks! appeared first on Reaching Milestones.

The scientific gist of this principle is as follows:  Any behavior that is more likely to occur in a free choice situation can be used to reinforce any behavior that occurs less likely in a free choice situation. Or to put it simply, “clean your room (low-frequency response) and then you can play video games (high-frequency response.) When the high-frequency response is made contingent upon the occurrence of the low-frequency response, it then becomes a reinforcer for the low-frequency response. In this case, the video game will reinforce the behavior of cleaning the room. Here the reinforcer is pretty easy to pinpoint. However, according to the “law” it can reinforce many behaviors that we normally would not think of.

• Example: When observed and given free choice to do as she wished, Sally’s most frequent behavior was computer play. At dinner she ate some of her vegetables, but not all of them. Without help or reminders, Sally did not do any of her homework.

• Most likely to occur = computer;

• Somewhat likely to occur = eating vegetables at dinner;

• Least likely to occur = homework.

According to the Premack Principle, anything above the target behavior can and will reinforce it. So yes, even eating vegetables would reinforce Sally for doing her homework, and playing on the computer would reinforce her for eating her vegetables.

For ages and ages the idea of “this before that” has been utilized in households everywhere, but how does this principle benefit the field of ABA and the clients that it serves? First, if reinforcers have been difficult to identify, this gives therapists a new perspective and the ability to identify properties of the free choice environment that are reinforcing. Secondly, once reinforcers have been established we can move past the starting line and begin to shape, increase, or acquire the skills necessary to promote effective behavior change for our clients.

The post Grandma’s Law: What is it (really)? appeared first on Reaching Milestones.