Monday, July 18, 2016

Challenging Behavior are a Source of Confusion and Stress

Parents usually ask me what to do with their kids when they are rigid and their tantrums are frequent and intense (lasting for long periods of time and being violent). Often times these kids have to be restrained to prevent them from kicking/punching holes in the walls and hitting others. A parent recently shared with me that her son becomes so aggressive that “his sisters run away from him and hide in the corner because they are scared of him.”  

Some of my recommendations include providing these kids with alternative things to hit and tell them that they can scream as loud as they want but inside their room. These strategies work, sometimes. But kids often refuse them.  So more intrusive strategies have to be implemented. I encourage parents to use distracting techniques. For example, redirecting their children to a coping kit: a box of sensory stuff to play with, such as squishy balls, hand pump, musical instruments, etc. It might take some time but eventually it helps to distract and calming them down.  

I’m not na├»ve. I know it gets confusing to decide what to do during the “eye” of the storm when the tantrum is at its peak and kids are at their most violent. Challenging behaviors are indeed a source of confusion and stress.

Parents can’t allow kids to bang on the walls/doors, or hit people in the house so sometimes they feel the only thing they can do is restrain them.  On those situations bear hugging them from behind is a good idea.     

Although restraining, distracting and redirecting to alternative activities are the right thing to do, they are not enough. I highly recommend to combine those strategies with highly motivating rewards when kids are not tantrumming and distracting them at the first signs (precursors) of distress to prevent the “storm” all together.  

Talking about their feelings is great. The more verbal communication the less "behavioral" communication. Teach them how to appropriately express wants and needs. And listen to them.

When possible make a plan together with your kids about the schedule of activities. Let's give him some control because otherwise they’ll “fight” for it.   

As difficult as they may seem, kids who seek control and communicate their feelings (even when the communication is through challenging behaviors) have a lot of potential and respond very well to the consistent implementation of effective behavior management strategies. When you withhold rewards contingent on problematic behaviors and consistently reward the non-occurrence of those behaviors they quickly understand that they are missing "the fun."

It is also important in those difficult situations to give them a "do-over" possibility. That way they regain control. Being angry and punishing for the rest of the... (session, day, outing, etc.) will only make the situation worse. The "as soon as you calm down you can play, let me know when you are ready" approach is very powerful.

And remember, tantrums are the best opportunity to teach kids they won't work.   

Daniel Adatto, BCBA



Monday, June 27, 2016

Behavior Management Tool Box III

Behavior Momentum

In this series of Behavior Management Tool Box I have previously presented Token Economy and Response Cost. Today I would like to present a very simple and yet powerful strategy for those kids that engage in non-compliance behaviors. As stated by Cooper, Heron and Heward in Applied Behavior Analysis, 2007, “Noncompliance is a prevalent problem in children with special needs and behavior disorders.”  


In one of our March 2016 blogs, I wrote about non-compliance behaviors:

Most disobedience can be avoided all together or at least reduced by taking the following steps:

1.      Try breaking down complex tasks into small steps, and ask your child to do one at the time. Cleaning up a messy room, for example, can be overwhelming. Starting with one or two toys or pieces of clothe can be very helpful in achieving compliance.
2.      Give your child choices when possible. For example, instead of telling her what to wear, ask her if she prefers the red or blue shirt.
3.      Be sure the direction is clear and concise. Start with a positive comment or interaction before giving a direction to perform a non-preferred activity.
4.      Be consistent. If you allowed your child to jump on the couch yesterday do not expect her to stop when you ask her today. If you discontinue the direction because your child throws a tantrum you are teaching her that you don’t mean what you say.
5.      Give your child time to process the direction. Prime her by telling her how much time is left until TV is over. Tell her it will be time to come to dinner after the video is over. In that way you provide your child with time to prepare for the transition.
6.      Some children may need visual schedules along with verbal directions. In addition having a picture schedule provides predictability and thus, reduces anxiety. Visit your child’s classroom or Google “Visual Schedules” for creative and motivating ideas.
7.      Motivate by making a preferred item or activity contingent on following directions. “First eat your vegetables and then you can have dessert.”
8.      Avoid giving directions when frustrated or stressed. If you are late to school asking your child to put on her shoes is not a good idea. Put them on yourself.


Let’s add to this list another tool: Behavior Momentum


Behavior momentum is strategy in which you first present your child with a series of easy-to-follow requests for which she has a history of compliance. Once she has complied with several (3 or 4) “high probability requests” in arrow, you present her with the target, “low probability” request. In that way you create a momentum of compliance that will likely reduce the probability of disobedience.


Let’s see an example to make this clear:

Mother: “Put on your shoes.”

Child: Avoids the non-preferred task by throwing a tantrum.

Behavior Momentum:

Mother: “Give me five.”

Child gives you five.

Mother: “All right, now catch this ball.”

Child: Catches the ball.

Mother: “Give me a hug.”

Child gives you a hug.

Mother: “I love you so much! Now give me your feet. It’s time to put your shoes on.”


Research shows that Behavior Momentum provides a non-aversive procedure (no need for getting upset, yelling, threating, etc.) for improving compliance by reducing behaviors that aimed to escape and or avoid instructions.

For this strategy to be effective you should present the high probability requests in rapid succession, with short or no intervals in between and reward your child’s compliance using very motivating reinforcers before presenting the low probability request.  


In sum, another strategy that must be part of your “tool box.”


Daniel Adatto, BCBA


Saturday, June 18, 2016

What to look for in an Applied Behavior Analysis (ABA) Intervention?

The road to finding the right treatment for your child with special needs can be confusing and cumbersome. Among other options, Applied Behavior Analysis (ABA) has unique features. I hope the following will assist you in choosing the most effective help for your child.

1.      ABA interventions are individualized: they are developed and carefully monitored to ensure progress for clients. Therefore, ABA is a continuous data-based decision making progress that guarantees “to be certain, through constant measurement and experimentation, that the particular case in hand is going well and will continue to go well,” as stated by Cooper, Heron and Heward in the preface of Applied Behavior Analysis, 2nd edition, 2007. Weekly and monthly meetings with the supervisor of the program should be provided so you have the chance to discuss progress on a regular basis.
2.      Priority is placed on identifying challenging behaviors and replacement behaviors, reinforcements, proactive and reactive strategies, behavior tools to implement those strategies, and parent/caregiver training.

The anticipated outcome would be for your child to make steady progress in a variety of domains, such as social skills, functional communication, independent living skills, etc.) while undesired behaviors are decrease/eliminated, thus ultimately reaching their maximum potential. The main objective is for the child to function independently in all of the developmental domains.

The following are anticipated outcomes specific to behavior:
·        Clients will learn appropriate coping strategies in order to deal with frustration, and manage disruptive behaviors.
·        Clients will decrease the frequency, intensity, and/or duration of maladaptive behaviors that prevent them from accessing community settings.
·        Parents and caregivers will learn strategies and techniques to help facilitate positive interactions with their child while learning to manage problem behaviors.
·        Clients will develop functional communication skills in order to communicate independently.
·        Clients will increase their ability to function independently in their environment by improving independent living skills (e.g., dressing, potty training, eating with a utensil, drinking from a cup, washing face/hands, brushing their teeth, money management, community safety skills, etc.).
·        Clients will increase appropriate social interactions while decreasing behaviors that focus on isolation.  
·        Children will learn functional play skills in order to increase positive social interaction with peers, relatives, and siblings.
·        Clients and their families will learn specific strategies and techniques to deal with problem behaviors when they occur in the community.

The “Applied” component of Applied Behavior Analysis means that interventions are conducted in natural environments (i.e. home, school and community), rather than in clinical settings. This allows for the direct implementation of learned skills, thus aiming for generalization across settings, people and time.

As a parent, look for, request and demand the above mentioned components.

In sum, by taking this individualized, data-based approach, we maximize the chance of success of the treatment plan.

Daniel Adatto





Thursday, May 19, 2016

The Wrong Idea

Today I would like to help you get rid of one idea, an idea that causes many problems. It is an assumption called “The little grown up”:  The idea is that kids are adults in small containers: they know the difference between what is right and what is wrong, they know how to control themselves, they are selfish and are motivated to follow directions. If your son is bothering her sister, you just need to explain him why it is not OK to bother others and your son will respond by saying “I never thought it that way. Thank you mommy, I’ll never bother my sister again.” Or “Yes, mommy, I’ll clean my room right away.”
No, kids do not respond that way. Somebody once wrote “Childhood is a temporary phase of psychosis.” It is our job as parents and teachers to turn them into reasonable people.  
If you believe in the idea of “little adults” it is very likely that more often than not you get into the “talk-convince-argue-yell” mode. You start talking to your non-compliant child. When that doesn’t work, you attempt to convince her. When that doesn’t work, you start arguing, which easily leads to yelling. When “adult reasoning” doesn’t work, you become frustrated and even angry. You feel that your child woke up that morning determined to make your day miserable.
So here is my suggestion: rather than thinking that your kids are “little adults” think you are a “child trainer, and educator.” Your job is to teach behaviors. And the same way you don’t get frustrated when your child says that 7 + 4 is 10, and instead you go on to explaining and teaching, when your daughter throws a tantrum in the supermarket you have to patiently leave the cart full of groceries aside, escort her outside of the store, help her calm down, and tell her that she’ll get an ice-cream if she helps you with groceries. You are a teacher who has a topic to teach, has a methodology of teaching and will repeat the lesson as many times as needed until the students learn. And if there is a student who has a harder time than others, will seat with him and teach him one-on-one. That’s a good teacher.
In this blogs I share with you methods and tolls to become a great teacher. Let’s cover today two main mistakes parents make when disciplining their kids:
1.      Talking too much
2.      Getting too emotional
In my 20 plus years working with parents I met devoted and patient ones that share two traits: they don’t give long speeches and they are emotionally detached when disciplining their kids. I mentioned above the “talk-convince-argue-yell” mode, which happens when you talk too much. Let’s see the getting too emotional mistake: Kids want to have control over a world that seems to be controlled by adults. And sometimes making you upset is the only way to achieve control, in their perception. Therefore, by getting upset, you are reinforcing the undesired behavior. I asked once a child I worked with why he seemed to enjoy making her mom mad. And his answer was “Because she makes funny faces.”
Talk less, do more. And always, no matter how frustrated you are, poker face. I hope this is helpful.

Daniel Adatto, BCBA




Monday, May 2, 2016

Practical Applications of ABA

In previous blogs I talked about some of the applications of Applied Behavior Analysis (ABA) and its use with autism. But I also tried to emphasize that ABA is not synonymous with treatment for autism. In fact, ABA can be applied to any situation where a behavior change is desired. And of course, the principles and strategies can be applied in every day parenting. Picky eating is a great example of this.  The same systematic techniques combined with positive reinforcement used to teach any skill can be used to address picky eating. If your child has a severe aversion to a certain food item, start with baby steps by breaking down each task into very small reachable components. For example, you can start by just having the undesired food on the table. Get the child used to having it there next to his other food and seeing other people eat it. Once he accepts the food on the table, you can move on to having him smell it, bringing it closer to his mouth. Remember that every successful step needs to be rewarded with, for example, a bite of a preferred food it (i.e. “First you smell the broccoli, then you can have Gold Fish.”).

Possible next steps can be to have the child lick the broccoli, getting him used to the taste. After that, move on to taking a bite. He may not even chew or swallow the food, just take a bite and spit it out. Remember, we are breaking this down into tiny achievable steps. After the child agrees to take a bite, you can move on to swallowing and so on and so forth until the child agrees to eat the broccoli.

The same principles and strategies can be implemented with problems such as brushing teeth, sleep in own bed, toilet training, etc.  

These baby steps may not be necessary with a typically developing child. Most of the smaller steps can be bypassed and the idea is simply to convey to the child that he at least needs to try the food before saying he doesn’t like it. If the child tries and does not like it, he can have a reward of something else to eat, then slowly move up towards eating more than one bite of the food the child refuses to eat. Eventually, you will be able to say to your child “you can’t have your dessert until you eat dinner” and the child will get the point.  Most children will usually give in to eating something over going hungry.

Always keep in mind that some food aversions can be related to allergies and should be checked with a doctor. Also, even adults have food preferences so if your child really does not like a certain vegetable there is no reason to ever force a food on a child. Be realistic with your expectations and relax.

Good parenting almost always involves offering choices and a loving approach that focuses on “the good” rather than “the bad”.

Love is the most powerful tool of discipline.   

Daniel Adatto, BCBA

Monday, April 25, 2016

Behavior Management Tool Box II

Some thoughts on response cost


In our last blog we discussed token economy, a system in which an individual earns tokens for desired behaviors. Once he has collected a predetermined number of tokens he can trade them for an item or activity of his preference.


Today I’m going to present Response Cost: a strategy which involves token economies. An individual is fined a specific number of tokens when he behaves inappropriately, with the hope of reducing that inappropriate behavior. As an example, if I were to drive too fast on the highway (which I would never dream of doing) I might happen to be stopped by the police and fined a certain amount of money (tokens). The faster I drive (the more inappropriate the behavior) the higher the fines. Similarly, one could create such a system in educational and home settings. For instance, if you've a child who occasionally refuses to work at a task, and you find the task important enough to insist upon compliance, you may choose to respond to the behavior with a response cost. So, if the child were collecting stars to buy a chance to watch his favorite video, you may consequence his initial refusal with the removal of a star from his chart. Continued refusals may result in higher costs (two or three or more pennies).

However, response cost needs to be considered carefully before it’s implemented. Setting up an aversive situation as a response cost may do, can cause the child to lose his trust on the system and present more challenging behaviors. Therefore, response cost is not for every situation.

Guidelines for using response cost effectively:
-     The behavior targeted and the amount of fine need to be explicitly stated. Always ensure that the child is well aware of what behaviors will result in the loss of tokens, and how those penalties will occur. Always ensure that there is a chance for the child to earn tokens back (i.e. “I’m taking a token away, but if you behave, you can earn it back”).
-     Ensure a sufficient reinforcement reserve: The child always have more tokens than what you are taking away. You cannot remove tokens if the child doesn’t have any.
-     You should recognize the potential of unwanted behaviors. The removal of tokens may result in outburst and aggressive behaviors. In those cases, either be prepared to “ride out the storm” or response cost should not be your strategy of choice.  
-      Response cost should be saved for major challenging behaviors. The teacher’s or parent’s attention should always be focused on positive behaviors. Response cost should be the last resource and rather than being implemented in isolation, it has to be combined with reinforcement procedures. The goal is always to build adaptive behaviors repertoires.

In sum, response cost must be part of your “tool box,” but should be implemented with caution.

And if not, I’ll take two stars from your reinforcement chart.


Daniel Adatto, BCBA



Tuesday, March 29, 2016

Behavior Management Tools

Today, I’d like to present an important behavior management strategy that, as a parent or teacher, should be part of your “tool-box.”

Token Economy: A token economy is a system in which an individual earns tokens for desired behaviors. Once he has collected a predetermined number of tokens he can trade them for an item or activity of his preference.

Tokens begin as essentially neutral stimuli, of little significance in themselves. However, as the tokens become increasingly associated with the reinforcers for which they are exchanged, they become motivating in themselves.
Money is probably the token economy system that is most well-known. There is nothing intrinsically motivating about it. However, because we can use those green papers to buy what we need and want, they can become extremely reinforcing.

Token economies can be used to meet a number of educational and behavioral goals for children:

·        Increased ability to delay gratification: Token systems are a great way to build a child's ability to wait for reinforcing items or activities.
·        Lessened satiation: By increasing the number of responses necessary to obtain a reinforcer, token economies can lower the rate at which the child becomes satiated with a particular form of reinforcement.
·        Increased teaching rate: Rewarding a response with a token is quick, and allows for speedy, more fluid instruction. In most school settings, it's uncommon to see teachers walking around handing out Fruit Loops, or passing out raffle tickets after every correct answer. Using tokens to delay the presentation of those more obvious reinforcers can be less obtrusive in the classroom.
·        Increased selection of reinforcers: Because reinforcement is being delivered after several responses rather than after each response, longer-lasting, possibly more reinforcing items or activities could be chosen for reinforcement. As an example, if one were conducting quick verbal drills, it's probably not effective to use a video as a reinforcer for each correct response. But, if a child finds a video especially rewarding, he may be willing to work for several tokens to earn a chance to watch.

What does a token economy system look like?

Token economy systems can take on a wide variety of forms. They can range from very simple, short-lived systems to much more complex systems that require the child to work for days or even weeks before earning his reward. For examples visit: https://www.google.com/search?hl=en&site=imghp&tbm=isch&source=hp&biw=1242&bih=599&q=reinforcement+charts&oq

Examples:
Punch card: Cammie was a girl who was constantly talking out and interrupting the proceedings. A punch card was introduced to help address those issues. Cammie was given punches if she was sitting and listening appropriately. After 18 punches she got a piece of candy and moved on to the next activity. As she progressed with the card, the interval between punches was extended, until she was working at five or more minutes between punches.

Puzzles: I've used puzzles successfully with children with autism and typical primary school kids as well. Take a picture of the preferred activity or item, let’s say computer. Laminate, cut in pieces (the number of pieces varies from child to child), and add Velcro. The child gets a piece of the puzzle for each correct response and can earn prizes for completing the puzzle. On top of the final prize, the puzzles are motivating in themselves.

Money: Money can make a very good token system for kids, especially older kids, where stickers and such might not be as appropriate. Working with money is a very functional skill, and using money as a token system lends itself to lots of great math concepts (making change, budgeting, etc.). For instance, you could set the price for a jump on the trampoline at five nickels, but might only hand out pennies as reinforcement. The child needs to figure out when he's got enough pennies to make a nickel and cash them in.

Guidelines for creating and using token economy systems

·        Token systems should clearly provide a visual representation of how much the child has accomplished and how much more he needs to accomplish before reinforcement is delivered.
·        Token systems are most effective at maintaining positive behaviors when they are specific to each child, address specific behaviors, and clearly communicate the expectations and rules to the child.
·        As when using any reinforcement, choice should be as big a part of your token systems. With simple systems have the child choose the item or activity he'd like to be working towards. With more complex systems you may have a "menu" of reinforcement posted along with the prices of various items (bubbles might cost 15 tokens, a video 60, a trip to McDonald's 150).

·        Pair verbal praise with the presentation of the token. Giving a "Good sitting!" or "Great reading!" will remind the child why he is getting the token and, when tokens have been established as secondary reinforcers, can help establish social praise as a reinforcer as well.


Daniel Adatto, BCBA
cadatto@tesidea.com