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.

Submitted by: Danica Samsin, QASP

In the ABA world, motivation is a key component to helping our clients succeed. These learners need to stay motivated! Our instructors spend countless hours getting to know our clients in order to decipher what really intrigues them and keeps them interested in what we are teaching them. They do so through observations, and running preference assessments throughout the day, a technique that allows our learners to choose what they are most interested in (i.e. edibles, activities, attention, etc.) prior to instruction. We call these “interests” reinforcers and they help our learners stay focused on the task at hand in order to receive their ultimate reinforcer at the end of their learning activity.

Children with Autism typically struggle with completing specific activities placed for them to complete, however, by clearly providing them with a specific reinforcer to earn at the end of an activity their motivation to complete the activity will increase and make them want to complete the task to earn that reinforcement.

 Through the use of edibles, activities, attention, and more, we find ways to motivate our learners to increase responding and decrease problem behavior. This also helps them learn new skills to communicate more effectively, use appropriate social skills, and overall, become independent successful individuals. You can say that we at Reaching Milestones are motivated to keep our learners motivated!

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Submitted by: Lara Lanza, M.Ed., BCBA

Hi, my name is Lara and I have been working for Reaching Milestones for the past 4 years and I wanted to tell my story about how Reaching Milestones inspired me to “reach my personal milestones!”

In April of 2013 I graduated from an undergraduate program at the University of North Florida. I had such a passion for children but was still unsure of what I wanted to do for the rest of my life. I met someone who took a class called Behavior Modification, which is what Applied Behavior Analysis was referred to years ago, and this person let me borrow some of her materials from the class to see if it sparked my interest. Once I read some of it – and saw how much this field impacts the lives of children with special needs – I was sold!

I began my first semester of Graduate School at the University of North Florida in August of 2013 and immediately began taking ABA classes! The first semester was spent learning different types of protocols and strategies to help better the lives of special individuals and it really solidified that this was the path for me.

In February 2014, I applied for my first job within the ABA field. I wasn’t completely sure how the practices I was learning in school would be implemented in the real world. I was lost and did not know where to search for such a facility to implement those amazing protocols. I did some research online and found some reviews for a few clinics and Reaching Milestones was first on my list – and thank goodness it was – because little did I know how much Reaching Milestones would provide so many growth opportunities and possibilities within my career!

Although Graduate School prepared me with tons of knowledge on different facets of the field, nothing prepared me more with such knowledge and growth than Reaching Milestones. Seeing the types of team members that RM had developed aspired me to want to REACH my own MILESTONES!

Through great preparation, I was able to reach many milestones within my career with the help of RM. Beginning as an RBT, RM prepared me for my future as a Board-Certified Behavior Analyst (BCBA) – which was the next milestone on my list! Through intensive training from fellow BCBA members of the RM team I was able to conquer the milestone of being a BCBA within the company. I remember thinking, “I did it! I achieved my goal! I reached my milestone!” I was so excited to finally be a BCBA.

Being a BCBA presented great opportunities to pursue further development within the company, and the next milestone on my list was to become a Supervising Analyst.

RM successfully created a path supplied with prodigious support and direction towards that next milestone I wanted to reach! Being a Supervising Analyst has really helped maintain the skills I learned within this applied field and keeps me on my toes, thinking of different types of strategies that work best for our children, based off the functions of their behavior.

But my path did not stop there. Currently, I am in transition from Clinical Coordinator to Clinical Director at one of the many successful Reaching Milestones centers.

Being a part of a company that does not show limits, but rather offers opportunities to excel, sets team members up for success! Not only does RM help such amazing children achieve milestone after milestone, but the organization really does prepare team members to achieve and reach their personal milestones – just like I did!

Through hard work, dedication, and a supportive company like Reaching Milestones, I can confidently say that I was able to achieve more than I thought would be possible within my career as a 26-year-old woman, and I have and I WILL continue to aspire to REACH MILESTONES!

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It’s Important to Listen!

Children with autism often have a difficult time attending to the words given by other people. They can be distracted by other noises in the room which makes it difficult for them to follow the instructions given by another person. Parents or caregivers who are giving listener instructions may have to compete with the inner thoughts of the child.

Children on the spectrum are taught listening skills in ABA based upon the VB-MAPP created by Mark Sundberg. Children can acquire listening skills based upon their atypical developing peers. We teach basic skills and then can move to more complex skills. Simple task of touching an item or finding an item to more complex of three step directives. When giving a directive to a child always be sure to connect the act with the demand, follow through with prompting the child with the correct response.

Teaching listening skills opens doors for the child with autism, such as being able to attend in school, attend to peers, and engage in conversation as active listeners. Listening skills are important in communication and in relationships. Teaching active listening skills to your child will help to benefit them in the long run and help them to be more successful in social and communication areas.

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Submitted by: Maria Whiteway, M.Ed., BCBA

In 2010 I became a special education teacher for children with autism. Given that my classroom was part of the Applied Behavior Analysis (ABA) program, I sincerely needed to learn a thing or two about ABA. Since I had several students who were non-verbal and others with limited verbal abilities, BCBAs trained me in Verbal Behavior. Simply put, Verbal Behavior applies ABA principles to language. While my intense training led me to become a BCBA, I still understand what it was like to hear unfamiliar terminology.

As parents, you are debriefed every session on your child’s progress. However, when a therapist uses terms like tact or intraverbal to describe your child’s accomplishments, you may walk away confused instead of delighted.

We know that knowledge is power, so here is a little cheat sheet on the ABCs of Verbal Behavior.

First and foremost, ABA is the science that implements behavioral procedures to improve socially significant (acceptable) behavior.

Again, Verbal Behavior is simply the application of these principles to language. Verbal Behavior can include talking, gestures, sign language, writing, using augmentative devices or utilizing picture systems. Verbal Behavior has been broken down into different verbal operants, so that we, as listeners, can respond appropriately to what a person is saying.

The main verbal operants will be explained using an ABC chart:

A= Antecedent (what happens before the child speaks)

B= Behavior (what the child said)

C= Consequence (what happens after the child speaks)

MAND

The first verbal operant is the Mand. Some common terms for this are request, ask, command, and/or demand. This operant is different from all others because when someone mands for something specific, they get it. Every other operant’s consequence is not specific to what was said.

TACT

The next operant is the Tact. Some common terms are labeling or naming. A tact has to do with the 5 senses. One can see, hear, smell, feel or taste something, so they will name what it is.

ECHOIC

Another operant is the Echoic. This is repeating what someone else says.

INTRAVERBAL

The next operant is the Intraverbal. Common terms for this are fill-in-the blank phrases (a pig says oink), word associations (socks and shoes), typical conversations and answering questions.

LISTENER RESPONDING

Another operant is Listener Responding. This generally involves people following directions. Think of it as the person is responding to what they are listening to or responding as a listener. 

MOTOR IMITATION

Motor imitation involves copying someone else’s movements.

Now that you know the ABCs of the main Verbal Operants, have some fun with them. When you are out and about, see if you can identify different operants that your family and friends produce. I know what it can be like to hear ABA jargon and wish you knew more. Hopefully this cheat sheet will help you, but if you still have questions, do not hesitate to ask your child’s therapist. You and your child are the most valuable members of the team at Reaching Milestones and we are always here to help!

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Submitted by: Katy Hudson, BCBA

When I first began my coursework in ABA, my professor stated that this field is very much like alphabet soup in that many terms are shortened into initialisms so it seems that there are just letters floating around. As a parent it can be very daunting when your therapist comes out with your child and states something along the lines of “The data shows the DRO we are using is effective” or “we are using an FR2 schedule and will work up to a VR 5.”, or when you see the weekly summary sheet and see notations like “Mastered 5 LRFFCs, 6 IVs, and 2 LR”. While we try our best to explain what each one of these terms are, it may be helpful to have an overview of some of the terms that are used.

Operants:

LRFFC – Listener Responding by Feature, Function, or Class. This means that your child is making a choice based on a feature of an item (“Find something red”), a function (“Which one cuts paper?”) or a class (“Where is a vehicle?”). We can also use this to have them make a choice based on all three, for example, “Find a yellow vehicle that takes you places” and the child selects a school bus or a taxi depending on what vehicle is in the array.

IV – Intraverbal. An intraverbal is essentially a response to a statement, answer to a question, or a fill-in-the-blank response. An example of an intraverbals is if I said “How was your day today?” and you stated “It was good!” Another example would be if I said “Twinkle twinkle little….” And you stated “star”. Day to day conversations are also examples of intraverbals.

LR – Listener responding. This means following verbal directions that are given.

Schedules of reinforcement:

FR – Fixed Ratio (commonly followed by a number, i.e. FR4). In the FR4 example this means that for every 4 responses, reinforcement will occur. So if I answered 4 questions correctly, I would then get a token for my token board or something else preferred.

FI – Fixed Interval. This has to do with a passage of time. For example, every 2 minutes I sit on my bottom in the chair appropriately, I would get reinforcement. However, if I got up after 1:30, I would not get the reinforcer because I didn’t make it to 2 minutes.

VR – Variable Ratio. This requires that a variable number of responses occur to receive the reinforcer. So for a VR 5, the responses needed to get reinforcement may be 3,7,4, and 6. These numbers average out to 5 responses (VR5).

VI – Variable Interval. This requires that a variable amount of time pass prior to receiving reinforcement. If we set a VI 2 requirement, the child may need to engage appropriately for 1 minute and then 3 minutes (which averages out to 2 minutes) to receive reinforcement.

Differential Reinforcement:

DRA – Differential reinforcement of alternative behavior. This means that we would reinforce occurrences of a behavior that is an alternative to the problem behavior. For example, we would praise tapping someone’s shoulder gently to get attention rather than hitting that person’s arm.

DRI – Differential reinforcement of incompatible behavior. This means that reinforcement would occur for desired behaviors that are incompatible with the problem behavior. An example of this would be praising a child for sitting in their seat rather than walking around the room. You cannot sit and stand at the same time so this makes these two behaviors incompatible with one another.

DRO – Differential reinforcement of other behavior. This means that reinforcement would be delivered when a problem behavior has not occurred during or at a specific time. For example, if you have gone two minutes without yelling, you would then receive your reinforcer.

While these are not all of the terms that are used in ABA, these are some that are frequently used and discussed with parents. Hopefully this will help in making clearer the alphabet soup that is our wonderful field.

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Submitted by: Stacey Francesconi, BCBA

There are big things happening for Reaching Milestones in 2017! Already an established agency in the Southern Region (Florida, Georgia, and South Carolina), Reaching Milestones strives to bring high quality ABA services to families in need. In the new year we are broadening our services to cover a new region: New York! New York state is a mandated insurance coverage state but with a lack of providers in the Upstate Region quality services are hard to come by. The following is the process that lead to the Capital Region getting its very own Reaching Milestones clinic!

My name is Stacey and I joined the Reaching Milestones team in 2012. I am a certified Special Education teacher who needed a change of pace. Once joining the team as a behavior technician I was hooked on ABA. I worked my way up to lead behavior technician, BCaBA, BCBA, and supervising BCBA in my 3 years at the Richmond Hill Georgia clinic. This was the best time of my life but I wanted to move back to my home state of New York to be with family. Once arriving home I realized the immense shortage of clinics who were like Reaching Milestones. Who am I kidding I was shocked at the lack of ABA in this area all around! I showed a need, met with lots of influential people, and proposed an offer to the leaders at Reaching Milestones. I was unsure if they’d be willing to expand that far or to give me a chance. After reviewing my hard work and the NEED in this area they decided it was time for Reaching Milestones to give these families in need the high-quality services they both needed and deserved. Now it was my time to make it happen!

We have had a lot of help along the way from doctors, families, other practitioners, and others in the field. Dr. Bentley from Developmental Pediatrics in Latham has been instrumental in getting our mission statement out to parents and believing in our contiguity of services. Janine Kruiswijk and the Autism Society of the Greater Capital Region have let us host parent trainings on toilet training and food acceptance. They have welcomed us to many of their events where we could spread the word on ABA. The amazing ladies at ABC Nursery School in Clifton Park have been the most welcoming and open hosts as we await our own building. They have let us use space to see a small amount of kids while we develop a client base and determine the perfect building space for our own clinic. There have been many others on the journey, too many to name, and we thank them all!

At this point we are credentialed with multiple insurance agencies, have a small group of clients, and have been hosting workshops and events. The future holds our own building with what I know will be an amazing staff. The process has been tough, and the hardest parts might not be over for me but in the end I know it will be worth it to help the families that need it right here in my hometown. I am so thankful for all who have helped and cannot wait for the next leg of this journey! Stay tuned on the Reaching Milestones Facebook page to see what NY is doing and feel free to contact me if you’re in the area and would like to be a part of this amazing journey.

Let’s do this NY!

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Submitted by: Lara Lanza, M.Ed., BCBA

You’re a mom of two children, trying to fit all of your daily necessities into a 24-hour day; seems impossible with two kiddos! Of course all of their “behaviors” emerge when you are trying to get “me” stuff done. On top of trying to get your “me” necessities completed, it is time for Christmas shopping! The kiddos scream of joy when they find out they are going to go Christmas shopping with you! The fear of having your kiddos want every toy in the store, especially the expensive toys, can be mind consuming. From mom’s perspective it may seem like a tedious task – but I have a solution!

Throughout my time working as a BCBA, I have come across some protocols that will be very helpful to the average mom who has trouble denying access to certain tangibles; especially when the price of such tangibles is out of mom’s price range. To moms out there, here is my advice:

We women love to carry nice big purses; one suggestion I might add is to fill those purses with some yummy delicious edibles for your kiddos. Carry backup supplies such as an iPad, tablet, cars, or little toys that your kiddos gravitate towards. These items will come in handy when trying to get Christmas gifts for the family.

Your child, whom is walking very nicely next to you, grabs an $80.00 toy from the shelf. Your little kiddo says. “Mommy! This toy is amazing! I have to have it!” The $80.00 price is out of your price range but you see the same toy but smaller for $40.00. You, being the best mom in the world, would love to buy everything in the store for your amazing kiddos but the $80.00 price range is not realistic. Mom, this is what you should do:

Inform your kiddo that the toy is not able to be purchased- decline access to the toy but offer the smaller similar toy paired with one of the really cool reinforcing items from your purse. “Bobby, no you cannot have that big toy today but you can have this smaller toy and your “skittles, iPad, or crackers etc.”

If Bobby does not comply- “Ugh Mommy! Why? I want that toy Mommy and begins to scream and cry-remove the skittles, iPad, or crackers by putting them back into your purse, block access to both the big toy and the little toy, ignore his problem behaviors, and continue shopping. Bobby no longer has the opportunity to have Mommy purchase that toy for him.

If Bobby complies and says, “Okay Mommy” then your master ABA mom skills have worked! Reinforce his amazing behavior by letting him grab the toy and put it in the cart and let him choose between the awesome reinforcers in your purse!

Way to go Mom!

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Submitted by: Beth Vaughan

The ABA community received great news last week! The NDAA (National Defense Authorization Act) Report included the directive for TRICARE to roll back ABA reimbursement rates to their level on March 31, 2016 upon the date of enactment of the NDAA Conference Report (when the President signs the Bill into law) and that those rates remain in effect until December 31, 2018!

The final language is a nice blend of the House and Senate NDAA bill language and directs TRICARE to use data gathered during the Autism Demonstration Program – and comparative commercial insurance claims (not rates) for the purposes of setting future reimbursement rates, review any beneficiary limitations on access to ABA at various military installations, determine whether ABA has improved outcomes for covered beneficiaries and to submit this analysis to the House and Senate Armed Services Committee.

This is not a guaranteed quick act, but this is excellent development! Stay tuned, as we will keep you posted as we learn more. Thanks again for your efforts in making this happen, Missy and Jamie!

The post “Be the Change” – VERY EXCITING UPDATE! appeared first on Reaching Milestones.

Submitted by: Beth Vaughan

Our very own Jamie Redding (Senior Vice President) and Missy Rolison (Vice President of Operations) for Reaching Milestones recently took a trip to Washington, DC last week to meet with members of the United States Congress. The mission of the trip was an extremely important one for all of us involved in both the Autism and Military communities.

Recently, it has become difficult for many military families to find in-network specialists for their children who have been diagnosed with Autism. According to a group of US Senators, this is in part, due to the way federal officials have changed health insurance plan reimbursements earlier this year. A group of six lawmaking senators (including North Carolina’s Thom Tillis) are calling for Congress to reverse the reimbursement cuts via additional funding and sent a letter to federal funding decision makers last week, asking for this very serious issue to be addressed. The letter asks for leaders on the House and Senate appropriations committees to include $32 million in upcoming budget legislation. That money is expected to effectively reverse the reimbursement rate cuts and address the shortage of ABA therapy providers.

According to the Senators, the reimbursement issue arose after Defense Health Agency officials changed the rate that TRICARE pays medical providers (such as Reaching Milestones) for Applied Behavior Analysis therapy. Through TRICARE, military beneficiaries diagnosed with ASD are eligible to receive ABA treatment. The Academy of Pediatrics fully supports and endorses ABA as an effective treatment for individuals with Autism. A Report of the Surgeon General states, “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior. The ABA treatment program is used by nearly half of the 26,000 children covered by TRICARE who have been diagnosed with Autism.

On April 1, 2016, the DHA imposed reimbursement rate cuts of as much as 15% for ABA services in most areas of the country. These cuts were imposed despite indications from military families from across the country that they were experiencing ABA provider shortages; and, in some locations, families had no access to providers at all. Just this week, 3 providers in San Diego were forced to shut their doors and a major ABA provider in the Georgia area had to close down all but one of their locations because they could not afford to stay open.

The House and Senate has already approved the National Defense Authorization Act for fiscal year 2017 to include reinstating ABA reimbursement rates. However, that bill does not appropriate federal funding for such costs and final approval of the budget is expected later this year (most likely December).

Missy and Jamie personally met with 10 members of the US Senate and were very enthused by the conversations that took place. They were able to lock in signatures from these representatives and came back to Jacksonville feeling very positive about the potential outcome.

This mission is far from over, and the efforts to reverse the rates don’t stop with the Jamie, Missy and the group of Senators. We need YOUR help! Sign the petition. Voice your opinions and concerns. Let TRICARE and Congress know how important ABA is for the future of your children. Progress is made every single day with ABA. Please contact your local congressman and senators to voice your opinion and let them know how important this is to all of us!

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