[FEAT BC Admin]

In this topic area, discussion is on all issues relating to setting up and running a home-based intervention program. Please feel free to bring up any problems or suggestions. Parents can help each other greatly by sharing information and giving suggestions.

In addition to parents helping parents, A.B.A. professionals on in the Discussion Group can also help provide insight and guidance.

Topic

[Sara White]

To jump off on the medical analogy again, I would disagree with the point on chemotherapy. If a person's chemotherapy isn't working informed consumers generally speaking will attempt to research other alternatives and then present them to their doctor and ask advice as to the evidence for and possible side effects of those treatments. As long as the individual doesn't go trying the interventions WITHOUT advice that would be the important point.

[Maureen St. Cyr]

1) I probably know as much about ABA as anyone on this list and I would never presume to offer programming advice to anyone. It would be irresponsible of me even if I knew the child. To offer advice as a non-professional in a vacuum without knowing the child is irresponsible in the extreme. And no, I will not sugar-coat that for anyone.

2) If your consultant's programming isn't working, tell them that and ask for changes. If your consultant isn't available, get another one who will be. If your chemotherapy isn't working, you don't start prescribing your own alternatives.

3) The place to discuss programming for a child is in that child's team meetings with the people who know the child and under the supervision of a qualified Lovaas-ABA consultant, not on a web site, or at coffee with well meaning friends or at a FEAT meeting or anywhere else. It is irrelevant whether well-meaning but ill-advised advice has helped in the past. Next time it may hurt, big time. You want to risk your child's progress, or worse? Go right ahead, it's a free country, but I will not take that chance.

4) My words are too harsh? Fine. This will be the end of them. I wish you all well. Goodbye.

[Deleted User]

I think she posted it anonymously because she was trying to be discrete. The chat board is a tool to talk about anything that might help that child's program. Not everyone can afford a number #1 consultant and not everyone has their consultant at their beckon call. And there are many times you have used your consultants ideas and they do not work PERIOD. If I would not have seeked out families and therapists to aide in our son's language program he probably would still not be talking to this day. I am so glad I did because my son is speaking now thanks to a therapists program.
I admire that person's intentions and noticing that there is a problem and doing their best to help the child. It probably took them alot of courage to post on here because each time you reach out, there is someone (usually Avery) beating them down to a pulp. People should be giving there experience or knowledge they have about the situation to help them if they can. If not then move on and not post an arguementive comment. People do their best in whatever situation they are in. We should not judge. I find there are more postings on the arguement of what people should post rather than helping them. Don't divide us intentionally.
To try and help…always look for the inconsistency from different environments and try to have expectations consistent. That would set off my son. Most importantly, show her at her level what is appropriate and what is not. At my son's level, when he needed it, we had a red and green square. Red side had a sad face and 4 different behaviours we were targeting drawn on there. Green side had a happy face and 4 appropriate things he could do instead. This worked well and eventually our teacher used it in class.
If she has lots of language maybe she could use that to communicate she is frustrated. Have her say before she hits, "i am mad" or "i don't like this". Of course eventually she would have to do the task at hand, but my consultant has always said to have our son communicate without agression and deal with it brick by brick. Eventually, when he got to a task he didn't like, he would say I don't like it or I don't want to do it, and that was the end of the learning there because our goal was for him to express without being aggressive. We then changed our focus to
him being able to complete the task without being agressive. We at first had to coax him through it and then that behaviour became a thing of the past. We used visual and verbal reinforcement.

I guess before the goal was to have her complete that task but now I think your goal has changed to have her communicate frustration appropriately and have her complete tasks without being aggressive. Hope this helps (even a little bit) and sorry you got your head chopped off)

I posted anonymously so I won't get my head bitten off too.

[Sharon Baxter]

This post is written in response to the post from Anonymous relating to decreasing aggressive behavior. The consultant's intervention was to use extinction, compliance and to increase reinforcement. As the therapist was seeking additional solutions I will assume these interventions, once implemented were not effective. There are many reason why these interventions may have not been effective. These reasons relate to the application of the interventions and not to the science of ABA in which these interventions were derived. Some of the reasons include:

1- The intervention procedures were not operationalized, and therefore the interventions were not implemented properly.

2-Accurate data was not taken.

3-The function of the behavior was not accurately identified and the intervention did not address the variable that was maintaining or increasing the behavior.

As a former senior therapist, I worked as a senior therapist in the Vancouver area for 7 years, I learned (through trial and error) how to effectively implement the interventions programmed by the consultant. Here are some suggestions on how to seek and implement behavioral interventions from your consultants.

A) As soon as a behavior begins to occur start taking baseline data.
Record the antecedent (what happened before the behavior), the behavior (describe the behavior, define the behavior in objective terms, hitting- one hand open palm striking another persons or object), and the consequence (child was removed from table, or instruction stopped while child told to stop hitting)

Record when the behaviour occurred, specific program, and who was instructing the child at the time.

Record the frequency or the duration of the behavior.

Graph the data immediately after each session.

2) Talk to the behavioral consultant. Fax the graph or describe the trend of the data, variable trend, ascending trend (increase in behavior), or descending trend (decrease in data). Describe the behavior in objective terms. Also include any information that is not included in the data. As Sara described therapists who are working daily with a child have insight that is valuable.

3) Have the consultant operationalize the intervention procedure. Ask for a step by step description of how to implement the program. Ask lots of questions. Visualized the program being implemented with the child, make sure you know what to do at each step. Anticipate problems; ask for instructions on how to deal with each. Clarify with the consultant; verbally repeat what you understand to be the procedure.

If a consultant tells you to deal with behaviour by putting it on extinction, go through the above steps. DO NOT ASSUME you know what a consultant intending.

3) Have the consultant complete a written behavior plan and data collection procedure. If your consultant will not do so, the senior therapist can write out the plan from the consultant's vocal description. The senior therapist should fax or email the plan for approval from the consultant.

4) During a team meeting the senior therapist should demonstrate the implementation of the intervention and have each therapist demonstrate implementation to show understanding.

5) For complicated procedures, video each therapist implementing the intervention and send the video to the consultant for critique.

6) Data should continue to be taken throughout each session, and graphed at the end of the session.

If the behavior does not decrease or changes topographies (form), the consultant will use the above data to refine the intervention. ABA is a science and requires the skillful implementation of procedures to be effective. I hope the above information will be helpful!!

Sharon Baxter

PS Happy Mother's Day

[Sharon Baxter]

This post is written in response to the post from Anonymous relating to decreasing aggressive behavior. The consultant's intervention was to use extinction, compliance and to increase reinforcement. As the therapist was seeking additional solutions I will assume these interventions, once implemented were not effective. There are many reason why these interventions may have not been effective. These reasons relate to the application of the interventions and not to the science of ABA in which these interventions were derived. Some of the reasons include:

1- The intervention procedures were not operationalized, and therefore the interventions were not implemented properly.

2-Accurate data was not taken.

3-The function of the behavior was not accurately identified and the intervention did not address the variable that was maintaining or increasing the behavior.

As a former senior therapist, I worked as a senior therapist in the Vancouver area for 7 years, I learned (through trial and error) how to effectively implement the interventions programmed by the consultant. Here are some suggestions on how to seek and implement behavioral interventions from your consultants.

A) As soon as a behavior begins to occur start taking baseline data.
Record the antecedent (what happened before the behavior), the behavior (describe the behavior, define the behavior in objective terms, hitting- one hand open palm striking another persons or object), and the consequence (child was removed from table, or instruction stopped while child told to stop hitting)

Record when the behaviour occurred, specific program, and who was instructing the child at the time.

Record the frequency or the duration of the behavior.

Graph the data immediately after each session.

2) Talk to the behavioral consultant. Fax the graph or describe the trend of the data, variable trend, ascending trend (increase in behavior), or descending trend (decrease in data). Describe the behavior in objective terms. Also include any information that is not included in the data. As Sara described therapists who are working daily with a child have insight that is valuable.

3) Have the consultant operationalize the intervention procedure. Ask for a step by step description of how to implement the program. Ask lots of questions. Visualized the program being implemented with the child, make sure you know what to do at each step. Anticipate problems; ask for instructions on how to deal with each. Clarify with the consultant; verbally repeat what you understand to be the procedure.

If a consultant tells you to deal with behaviour by putting it on extinction, go through the above steps. DO NOT ASSUME you know what a consultant intending.

3) Have the consultant complete a written behavior plan and data collection procedure. If your consultant will not do so, the senior therapist can write out the plan from the consultant's vocal description. The senior therapist should fax or email the plan for approval from the consultant.

4) During a team meeting the senior therapist should demonstrate the implementation of the intervention and have each therapist demonstrate implementation to show understanding.

5) For complicated procedures, video each therapist implementing the intervention and send the video to the consultant for critique.

6) Data should continue to be taken throughout each session, and graphed at the end of the session.

If the behavior does not decrease or changes topographies (form), the consultant will use the above data to refine the intervention. ABA is a science and requires expert implementation of procedures to be effective. I hope the above information will be helpful!!

Sharon Baxter

PS Happy Mother's Day

[Sara White]

While I do agree that team members should not be implementing interventions without first having the approval of the consultant, I disagree that they should not be attempting to come up with potential interventions. Depending on the position of this particular team, it is possible that their consultant may only see the child once every three months or so. If this is the case, while the consultant does have extensive knowledge regarding principle and application of behavior analysis and specific techniques for reduction of aggression, he or she does not have an intimate knowledge of that particular child. Yes, behavior analysis is a science, but there is also a certain art to that science as it currently stands. There is no single intervention that is universally appropriate for reduction of aggressive behavior. There is also not a formula that can be used in which child characteristics and problem behaviors are entered and the most appropriate intervention is calculated. As such, knowledge of BOTH behavioral principles and the specific child are necessary but do not provide an automatic answer.
Speaking as a consultant who has been in a similar position, some of the most effective suggestions for interventions or pieces of interventions have come from team members who work on a daily basis with the child and have an intimate working knowledge of the behavior problem in question. I do wish to stress, however, that there is a chain of command so to speak that should be followed. Team members should feel free to make suggestions to their consultant and work with them in a collaborative fashion, but they should NOT implement those ideas without first speaking with their consultant.
To go back to the medical analogy, nurses are the front line workers in a hospital setting. They too have some knowledge medical interventions as they implement these interventions on some level daily. They also likely have a more intimate knowledge of the current status of the patients than doctors do as they have more contact with individual patients. If they notice that an intervention is not effective and also notice that due to particular patient charactertics that another intervention may be more appropriate, while they would never implement the intervention without first consulting the doctor, they do have a certain ethical obligation to bring both of these factors to the doctors attention. I think that a therapists relationship with a consultant should be viewed in the same way.

[Deleted User]

Oh my god, " Bunch of stranger "?, we are all here to help each other, and for the Anonymous you don't have to say sorry for anything is like you say before this list is like other list we are here to provide support and get some help from parents and professionals.

[Deleted User]

I'm sorry that the post was taken so wrong! Of course we are doing everything as stated by the consultant… we were just wondering if anyone had any other ideas to help cope with the behaviour or to provide support during this stage. Just like any website, support group, peer review journal, or book on ABA therapy would provide ideas, that is what the intent was. I wasn't doing it anonymously to protect myself, and the family is fully aware of the post. I have done my education in order to dedicate myself to doing the best I can for these children. It hurts that this was read the wrong way..I am definitely not a deceitful person! I am sorry for offending you.

[Maureen St. Cyr]

>Re: I am posting this on behalf of a team I am a member of…

With all due respect, it is not the place of therapists on a proper Lovaas-ABA team to be looking for suggestions from other parents on programming of any kind, let alone programming around aggressive behavior. If the consultant has put in programming, it is your place to carry it out, period. If you have questions or concerns about the program, you take them up in your team with the parents and the consultant, not with a bunch of strangers on a mailing list who know neither you nor the child. There is no magic about posting anonymously that gives you the right to step out of line on this, and whoever you are, I suggest you NEVER do it again.

If you think I am being rather forceful about this, consider the following analogy:

You are a nurse working in a hospital on a complicated case involving a patient with a serious medical problem. The doctor in charge of the case has given you instructions for the patient's care. Instead of following the instructions, or bringing your concerns up with the doctor, you have called a bunch of friends who have some knowledge but no medical credentials or training, given them private information about the patient, and then asked them for medical advice.

If you were a nurse, you would be in line for severe disciplinary action. As an ABA therapist, you have the same ethical code of conduct. Don't breach it again.

[Deleted User]

I am posting this on behalf of a team I am a member of. We are looking for any suggestions on how to extinguish aggressive behaviour – specifically hitting. This young girl (who has been in therapy for several years) has been striking out when called to the table for some drills, usually ones that require sentence responses or phonetics. Another scenario in which she has hit therapists is during Pretend Play with blocks. We try to incorporate a "play" situation with a finished building (which she correctly copied with no problem whatsoever) by adding a toy animal or person. She also strikes out when a therapist intervenes on inappropriate use of toys, or when guided through a structured play activity with a schedule. This behaviour has been present in school and seems to have perhaps carried into the home therapy program. Our consultant has suggested extinction, compliance, and increasing reinforcements. This is a new behaviour for her, as she is usually cheerful and enthusiastic. We were wondering if anyone had any suggestions or ideas about what we could do to extinguish this hitting? Any thoughts would be greatly appreciated!

[Author]

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