Submitted by: Chelsea Silva, QASP

We are so thankful to have the opportunity to work hand-in-hand with our incredible parents as part of our client’s treatment team. We only see your children for a portion of time each week so it is vital that we work together to create a plan that is deeply rooted in the science of Applied Behavior Analysis and fits naturally into our family’s everyday lives. In order to see change across the board we greatly appreciate active participation from our families!

But what does active participation mean? Active participation includes working together side by side with your child’s therapist during parent training sessions or when meeting to discuss the treatment plan, completing assignments such as recording behavior, obtaining information from your physician, making changes in home and routine as needed, and effectively communicating successes and challenges. In order to help our families feel comfortable and confidant in their participation we put an emphasis on systematic parent training. We strive to give our parents the tools to not only implement individualized protocols utilized to increase or decrease behaviors, but also to help generalize those increases and decreases to different places, different people, or during changes to routine (such as vacations).  During training we use what is called behavioral skills training to provide clear instructions, guided demonstration, opportunities for practice, and immediate feedback. We strive to break down each skill in such a way that it is easily understood followed by demonstrating the protocols or teaching procedures so that our parents have ample opportunities to ask questions throughout the demonstration. After initial instructions and demonstrations we provide opportunities to practice with us during role play activities to ensure you are comfortable and confidant before trying to do things independently with your child. Throughout the process we will be giving you immediate feedback with both spoken feedback and at times collecting data on progress so you can visually see how you’re doing!

Through this systematic teaching process we hope to help our parents to feel ready to tackle problem behavior independently, ready to teach using new strategies, and ready to implement across environments! We always strive to set our clients up for success, and we want our parents to feel the same level of support so they may be successful as well! We thank you again for your continued support and active participation, we love to work together with you and be on your team!

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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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         There are several potty training procedures that have been found to be effective.  The first recommended method is referred to as graduated guidance.  Graduated guidance is a prompt based method using “behavioral chaining.”  Behavioral chaining involves reinforcing closer approximations of the behavior targeted (using the toilet).  In this procedure you begin with the least involved prompt to start the chain.  For example you may bring the child to the potty and stand there with an obvious pause, if they don’t begin the process of undressing to use the toilet then point to their pants (gesturing to pull them down), if need be you would then present a verbal prompt, and finally move on to increasing levels of physical prompting.  In the event that graduated guidance is successful there are other more involved procedures available.

         One empirically based procedure that we have been using is based on the protocol from Kimberly Kroeger and Rena Sorensen (2010).  The purpose of the procedure is to teach self initiation through a sitting schedule.  The sitting schedule is:

• 30 minutes sitting on the toilet, 5 minutes off (for successfully going)
• 25 minutes on, 10 minutes off
• 20 minutes on, 15 minutes off
• 15 minutes on, 20 minutes off
• 10 minutes on, 25 minutes off
• 5 minutes on, 30 minutes off

If the child successfully urinates/defecates on the toilet (even if there is more time on the toilet) their minutes off automatically begin, and if they go during their time off the time off restarts.  Each time they have successfully gone 3 times in a row you move down to the next sitting schedule.  Once they have reached the 20 minutes on, if they are not already self-initiating then a chair is introduced.  You begin by placing a chair 2 feet away facing the toilet and once they have successfully gone 3 times in a row you move the chair 2 feet further away from the toilet.  Once the chair is 20 feet away you start decreasing the time again.  This teaches them the sensation of their bladder being full and needing to stand up from where they are to independently go to the restroom.

            Potty training children with developmental disorders may seem overwhelming, but these two protocols have been shown through data based research to be effective methods of potty training in both neurotypical and autistic children.  With consistency, patience, and a plan toilet training will be quick and effective, and your child will benefit from the independence and comfort of being able to self-initiate.

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In order to identify the function of the problem behavior, look out for what is taking place in the child’s environment right before the behavior occurs. Common antecedents are: being told “no”, interruption from preferred activity, transitions, being ignored (low attention), and aversive tasks.  The function of problem behavior is typically parental attention, access to preferred items/activities, access to preferred foods, and escape from aversive tasks.

The following three procedures either used alone or combined, target the various functions of problem behavior.

Planned Ignoring (Extinction):  Problem behavior is reduced by withholding reinforcement specific to the motivating operation (i.e. child is not allowed access to the item or activity they want) (Iwata et al, 1994). To implement this procedure, block access to all reinforcers and minimize your attention towards the child (no eye contact, talking, or unnecessary touching). When the behavior has stopped for 3 seconds, give the child some attention and redirect them to a different item or activity.

Count & Mand:  This procedure is to be used when a reinforcer is available. With this procedure, you are teaching appropriate asking for an item/activity as opposed to the child exhibiting problem behavior. This procedure includes telling the child for example, “no hitting”, and then prompt them to keep their hands down and begin counting to 5 verbally and with your fingers. If the child does not exhibit problem behavior for the full 5 seconds, prompt an appropriate mand and reinforce their response. If the child does emit inappropriate behavior during those 5 seconds, restart the wait interval. If you do not receive an appropriate response and have done the wait interval many times, withdraw the reinforcer without saying anything (the opportunity to receive the reinforcer has ended). (Procedure is derived from Dr. Vincent Carbone).

Transition:  The purpose of this procedure is to transition your child away from a preferred activity without problem behavior. The procedure begins with offering a transition reinforcer for leaving the activity without inappropriate behavior. If a child exhibits problem behavior, remove the transition reinforcer and block access to other reinforcers while minimizing attention. Continue to place the demand of transitioning to the next activity and provide praise when your child begins to transition. Once the transition is complete and they have begun the next activity, provide additional reinforcement. Alternatively, if your child transitions without problem behavior, deliver the transition reinforcer as soon as the transition is complete. (McCord, Thomson, & Iwata, 2001).

Remember, it may take some time to become used to the protocols, but research has shown that the consistent use of the problem reduction procedures will decrease problem behavior. Do not become frustrated if your child’s behavior becomes worse, before it gets better. We call this an “extinction burst”, which means the child is trying everything they can to receive an item, get your attention, etc. and the problem behavior will decrease once they are no longer being reinforced for their inappropriate behavior.

References

Carbone, V. J., Morgenstern, B., Zecchin-Tirri, G., Kolberg, L. (2010).  The role of the reflexive-

            conditioned motivating operation (CMO-R) during discrete trial instruction of children

            with autism.  Focus on Autism and Other Developmental Disabilities, 25, 110 – 124.         

McCord, B. E., Thomson, R. J., & Iwata, B. A. (2001). Functional analysis and treatment of self-

            injury associated with transitions. Journal of Applied Behavior Analysis, 34, 195-210.

Iwata, B.A., Pace, G.M., Cowdery, G.E.,  Miltenberger, R.G., (1994).  What makes Extinction

            work: an analysis of procedural form & function.  Journal of Applied Behavior Analysis,

            27(1), 131 – 144.

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