Cleveland ABA therapy provider

Choosing the Right Cleveland ABA Therapy Provider for Your Child With Autism

ABA therapy is widely considered the gold standard treatment for children on the autism spectrum – and it’s particularly valuable when it’s intensive, starts early, and is combined with other critical interventions, such as speech therapy and occupational therapy. That said, finding the right Cleveland ABA therapy provider for your child can seem daunting – particularly if you’ve already had a negative experience.

When implemented appropriately, ABA has proven unequivocally to help children learn invaluable skills in areas like communication, self-regulation, social interactions, and self-care. It is our firm belief and practice that the best form of ABA therapy is naturalistic, play-based, and enjoyable for the child. That’s not to say we don’t challenge our patients. We do, as it’s necessary for them to gain the skills we’re trying to teach them. However, sessions that are too intense, rely too heavily on negative reinforcement, or use goals that are beyond what is realistic for a child will not only yield less progress, they may actually set your child back.

The unfortunate reality is that not all ABA therapists are cut from the same cloth, and not all clinics hold themselves to the high standards that we do at Therapy & Wellness Connection. Unlike more established fields like speech-language pathology, occupational therapy, or physical therapy, ABA therapy is less regulated.

Certified behavior analysts, or BCBAs, do have an intensive credentialing process. Among the requirements for BCBAs:

  • Earn at least a master’s degree or doctoral degree in Behavior Analysis or related field such as psychology or education, with a focus on behavior analysis – with courses covering ethical conduct, principals of behavior analysis, research and data analysis, problem identification & assessment, intervention consideration, implementation management, etc.
  • Complete a minimum 1,500 hours of relevant, supervised experience in an ABA setting.
  • Pass a national certification exam.
  • Apply for certification with the Ohio Board of Psychology.
  • Attend a Pre-certification workshop and exam on Ohio ABA regulations (as detailed in Chapter 4783 of Ohio Revised Code and the Ohio Administrative Code).
  • Renew COBA certification every two years (which requires proof of at least 23 hours of continuing education, with a minimum 4 hours of training in ethics, professional conduct, or cultural competency).

While these standards align with what one might expect in a field of professionals working one-on-one with children who have complex behavior needs and challenges, the same is not true of registered behavior technicians, or RBTs. And it’s RBTs who primarily administer Cleveland ABA therapy – under the supervision of a qualified BCBA.

RBTs are paraprofessionals. They are required to meet the basic eligibility requirements (at least 18-years-old, have a high school diploma, pass a background check, complete 40 hours of training, complete an initial competency assessment), then apply, take & pass the RBT exam, and then maintain their certification with ongoing supervision, adherence to ethics, and annual renewal. So where as it takes hundreds and lots of education to become a BCBA, RBTs are providing the frontline care with 40 hours of training.

Of course, there are many RBTs who are excellent and provide stellar ABA services to their clients. There is ample scientific data supporting the value of ABA in general. But as the number of autism diagnoses has risen steadily over the last two decades (the CDC estimates 1 in 44 children has an autism diagnosis), so too have the industries that serve them. Not every provider or clinic is as rigid about who they accept or how much oversight they receive. That can compromise the quality of care, as the value of ABA therapy rests heavily on who is administering it.

All of this can feel overwhelming for parents looking to find the best possible treatment for their child.

Our TWC Cleveland ABA therapy team has some questions parents can ask to determine whether a clinic/ABA therapy provider is right for your child:

  • What is the ratio of BCBAs to RBTs at your clinic? The lower the ratio, the better, but there may be some variation depending on their patients’ severity level.
  • What training and expertise does your staff have? As mentioned before, BCBAs must have extensive education and training, and they are the ones who will be developing treatment plans for your child. But it’s the RBTs who will be implementing them. Ask whether the providers encourages staff to undergo ongoing training. Inquire whether they have direct experience with your child’s specific challenges and needs.
  • What types of intervention are used in your ABA clinic? ABA therapy is not a one-size-fits-all approach. There are actually many different ways to administer this research-based treatment. Ask the provider about their therapy philosophy and approach. Some tend to use more discrete trial training (which is more systematic and usually involves a child sitting at a table) while others prefer a more natural, organic approach to learning. Some therapy clinics will use both, depending on the child. You will also want to know whether they use positive reinforcement. “Punishment” or negative reinforcement may be effective in altering behaviors, but it’s not necessarily the best approach – especially because when there is potential for it to be over-used or abused. Positive reinforcement should be the primary approach.
  • Does your clinic provide any other specialized services? Children on the autism spectrum may be prescribed a number of treatments, including speech therapy and occupational therapy. They may also benefit from tutoring, homeschooling, social skills groups, specialized therapies (music, equine, etc.), etc. It can be very helpful for these kids to have a “one-stop-shop” for these services. Therapy & Wellness Connection is one such place where kids can receive multi-disciplinary services and interventions.
  • What is the treatment plan? Treatment plans must be created specifically for your child, depending on a functional behavior assessment. The plan should include both proactive and reactive strategies to manage and reduce problematic behaviors and encourage socially appropriate behaviors/responses. Ideally, the plan of care is going to have clear functional goals and objectives that identify age-appropriate challenges that are both engaging and fun for the child – and most likely to be generalized into other environments. It should also include parent involvement and training, to some extent. The more carryover we can get across environments, the better.
  • What sort of safety measures are in place at your clinic? You as a parent want to know what measures are taken to prevent abuse, what the procedure is for reporting concerns with parents, how often parent observations are allowed, how inappropriate/excessive/dangerous behaviors may be dealt with, etc. You also want some insight into how secure the facility/session will be, particularly if your child is at high-risk for self-harm or elopement.

If your child has been diagnosed with autism and referred to Cleveland ABA therapy providers for services, our team at TWC can help answer any questions you have about our staff, our facility, our philosophy, and our practice.

Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy to children in Akron, Cleveland, Brecksville-Broadview Heights and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

Low standards corrode quality of popular autism therapy, By Emily Sohn, Oct. 28, 2020, Spectrum News

More Blog Entries:

Cleveland ABA Therapists on Differences Between Bribery vs. Reinforcement, Sept. 10, 2022, Cleveland Behavior Therapy Blog

Cleveland ABA therapists

Cleveland ABA Therapists on Differences Between Bribery vs. Reinforcement

As Cleveland ABA therapists, so much of what we’re able to achieve with our pediatric patients is because of our tactical use of reinforcement. Reinforcement can be positive (game time, a sticker, a favorite song/dance, a gummy treat) or negative (typically ignoring or denying a preferred activity). Where possible, we lean toward the use of positive reinforcements. But we recognize that from the outside looking in, this might seem like bribery.

So, what’s the difference between bribery and positive reinforcement in Applied Behavior Analysis treatment for kids on the autism spectrum?

Here’s our Cleveland ABA therapists generally outline the difference:

  • Bribery is what takes place when a child has already started engaging in a problematic or unexpected behavior and then something like screen time or a special treat is offered in an effort to get them to stop engaging that behavior. It’s not really used as a learning moment or opportunity for a child to gain a new set of skills or engage in a different pattern of behavior. Bribery often stems from a one-time interaction where a child gets some sort of preferred item, food, or activity in exchange for changing their behavior. It might be effective in the short-term (which is why so many parents use it!) but that behavior is going to happen again and again – and won’t change unless you offer the same/similar “bribe” to offset it. Ultimately, it’s the child who maintains control in this scenario.
  • Reinforcement occurs when the preferred item or activity is given only after – and contingent upon – the expected/appropriate behavior change. That might sound really similar to bribery, but we’re delivering the reinforcement only after we see the child “change the channel” and their behavior as a means to increase that behavior.

To illustrate the difference, let’s give a dinner time example.

Let’s say you’ve spent time preparing a meal for your family and place it in front of your child and encourage a bit. The child immediately bursts into tears, throws themself on the ground, and demands chicken nuggets. You respond, “If you will stop crying, I’ll go make you some nuggets.” The crying stops, the child gets their nuggets – win-win, right?

Except that was bribery. It “fixed” the immediate issue, but the same scenario is going to happen again and again – and your child isn’t going to eat their dinner if they know chicken nuggets are on the table as on option – if they have a “big reaction.”

Instead, our Cleveland ABA therapists would recommend a reinforcement approach. Take a deep breath. Then rather than wholly giving in to the child’s demands, make them this deal: You will make chicken nuggets. Plan to do so ahead of time, in fact, if you know this is likely to be a point of contention. Then you use the chicken nuggets as the reinforcer. You require first a bite of dinner in exchange for each chicken nugget. With this tactic, you are reinforcing the expected behavior (eating the dinner you prepared) with the reinforcer (they chicken nugget they really want).

In the end, the goal of “bribery” is for the person giving the “bribe” to get what they want. But with reinforcement, the goal is ultimately to benefit the child/learner.

When we talk about reinforcement tactics in ABA, we sometimes hear from parents that they are reticent to “bribe” their child to do what’s expected of them in the first place. But this is where they are confusing bribery with reinforcement.

Look at this way: If what you’re doing is not effective, trying something new may be necessary. And reinforcement involves a bit of planning on your part. You know your child is likely to take issue with the dinner you prepared. Set them up for success by motivating/teaching them upfront.

Cleveland ABA Therapists Tips for Parent Positive Reinforcement

As ABA therapists, our sessions take a fair bit of planning to ensure we’re targeting the goals/skillsets of each child with whom we’re working. But parents can use some of these same basic strategies at home to help facilitate desired results.

A few ideas:

  • Catch” expected behaviors. You may already be planning to provide your child with some type of treat, like game time or some chocolate. All the better if you can do so after “catching” them engaged in expected/appropriate behavior that you want to target or encourage. The more you do this, the more expected behaviors you’ll see.
  • Make sure you’re targeting an appropriate behavior to reinforce. You want to be sure it’s something your child is actually capable of. Start with easier tasks and then work your way up to more challenging skills. Remember: You want to set them up for success and improve their confidence that they can reach their goals!
  • Keep an eye out for warning signs. In ABA, one of the first things we learn is to study the “ABC’s” of behavior. This involves carefully observing the antecedent (what happens right before an inappropriate behavior), the behavior itself, and then the consequence. By altering either the antecedent or consequence, we can help children alter behaviors and gain new skills. Watching out for warning signs is knowing what antecedents are likely to trigger a meltdown or other inappropriate behavior that you’re trying to target. Go into situations you know may be triggering prepared with tools to help reinforce when they engage in expected/appropriate behaviors.

In the event a tantrum or meltdown occurs, it’s important to wait until they are in a calmer place before initiating any sort of reinforcement. (They’re unlikely to be able to respond much at all when they’re in such a heightened, emotional state.)

When they do start to calm down and get a reign on their emotions: Praise them for it! This is positive reinforcement to. Praise them using their calm-down strategies (deep breaths, counting to 10, squeezing their palms, etc.). Then when they are truly calm enough to engage in meaningful communication, you can outline the terms of the reinforcement (i.e., three bites of dinner = 1 chicken nugget).

If you have questions about the difference between positive reinforcement and bribery and how best to implement positive reinforcement at home, our dedicated Cleveland ABA therapists can help.

Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy to children in Akron, Cleveland, Brecksville-Broadview Heights and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

Applied Behavior Analysis, Autism Speaks

More Blog Entries:

How Our Cleveland ABA Therapists Teach Kids With Autism Personal Hygiene Skills, Aug. 11, 2022, Cleveland ABA Therapy Blog

Cleveland ABA therapists teach kids hygiene skills

How Our Cleveland ABA Therapists Teach Kids With Autism Personal Hygiene Skills

Most kids struggle at first with independently maintaining good personal hygiene. Kids on the autism spectrum may have a tougher time with it than most. Our Cleveland ABA therapists can help.

It’s important to understand why kids on the spectrum might have more significant difficulties with things like handwashing, teeth-brushing, and washing their body in the bath or shower. Much of it relates directly back to their diagnosis. Some of the skills needed to independently maintain one’s hygiene include:

  • Fine motor skills.
  • Time management/organization.
  • Attention to a non-preferred task.
  • Executive/cognitive functioning.
  • Sensory regulation.
  • Receptive language skills (understanding the directions being communicated with them).
  • Ability to follow multi-step directions.

Some of the key personal hygiene skills we really want kids to master (even if they take some additional time to do it) are:

  • Cleaning/brushing one’s hair.
  • Handwashing.
  • Nose blowing.
  • Toilet training.
  • Oral hygiene (teeth brushing, mouth washing, floss, dental checkups).
  • Nail care (trimming and cleaning fingernails and toenails).
  • Skin care (may vary from child-to-child).
  • Managing periods (for those menstruating).

These are things many of us adults simply take for granted as being simple, everyday chores we don’t think twice about. However, when you truly break each one down into all the individual steps – from recognition of an issue to proper completion – these tasks are more complex than they initially seem.

We like to try working with kids on the spectrum at a very young age on these issues because the earlier we start, the greater their self-sufficiency by the time they reach their teens. Not only is good personal hygiene vital to one’s health and well-being, but poor hygiene is a social stigma that can quickly lead to a child becoming socially ostracized.

Depending on the severity of their condition, your child may continue to need assistance with certain personal hygiene tasks even as they get older. However, the more independence they can gain, the better off they will be in the long-run.

Cleveland ABA Therapists Use “Chaining” to Teach Hygiene Skills to Kids With Autism

Our primary approach when we’re working to teach kids on the autism spectrum how to maintain their personal hygiene is a behavioral therapy technique called “chaining.” It involves breaking down a certain skill into the very smallest parts possible, teaching those skills independently, and then “chaining” them together.

For example, let’s say we’re trying to teach toothbrushing. Kids with autism may have strong sensory aversions to having bristles and toothpaste in their mouth – or even near their face. What we may do is start by working with them just to touch the toothbrush. Eventually we’ll work our way up incrementally to get them comfortable with having the toothbrush in their mouth. Then with moving it around. Then with a little toothpaste.

When we start with the smallest components of a task, it gives the child real success – and confidence – every time they master each little step.

Parent Practice for Personal Hygiene

Lots of parents will prefer to handle certain personal hygiene skills like bathing and toilet training at home. Our Cleveland ABA therapists can help coach parents through these processes, providing tips, visual supports, and reinforcement during our sessions.

Some basic tips we have:

  • Create daily routines. When kids know what to expect, they have an easier time engaging in a task, even if it’s not preferred. Kids on the spectrum especially thrive on routine. Ensuring when possible that these tasks are done at the same time in the same order with the same tools will allow the child to stay better regulated during these tasks and offer more opportunities to practice.
  • Use visual supports. These would be pictures that represent a certain activity, routine, or schedule. If they can read, their might be large, bold, simple text. Visual supports help to create structure and guidance and can reduce anxiety, frustration, and challenging behaviors. Our ABA therapy team can also help parents create a “social story” that the child can read throughout the day or week to help reinforce the lessons you’re trying to teach.
  • Prompting and fading. Prompts are actions that help a child complete a certain task or demonstrate a certain behavior. Prompts can be a verbal instruction or a physical gesture or a visual support. You might start off with a lot of prompts early on when you’re first trying to teach a skill. Then later, as the child begins mastering certain key elements of the task, you can start to “fade” those prompts.

If you are struggling to help your child with autism master certain personal hygiene tasks, our Northeast Ohio ABA therapy providers can help.

Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy to children in Brecksville-Broadview Heights, Cleveland, Akron, and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

An Approach to Cleanliness Training to Support Bathroom Hygiene among Children with Autism Spectrum Disorder, February 2018, Behavior Analysis in Practice

More Blog Entries: Stimming with Autism: FAQ With Our Cleveland ABA Therapists, July 24, 2022, Cleveland ABA Therapy Blog

Cleveland ABA therapists

Stimming with Autism: FAQ With Our Cleveland ABA Therapists

Our Cleveland ABA therapists are far from the only ones who are well-informed on the fact that restricted interests and repetitive behaviors are among the primary criteria for defining autism in diagnostic criteria. What is less common knowledge, however, is the fact that this can encompass a very broad range of traits that can appear in a vast array of varying combinations and with different levels of severity. Stimming, a common behavior among people with autism, can be generally be understood as a form of repetitive behavior – but it gets a little more complicated than that. And understanding WHY people do it is important to informing how we approach it in therapy, at home, at school, and in everyday life.

Repetitive behaviors are among the first to appear in very young children with autism. They’re often apparent for people across the spectrum, but they may be more obvious or pronounced in those with cognitive deficits. However, they are less studied (and therefore less understood) than the other primary identifier of autism: Social and communication difficulties.

What Exactly is Stimming – and How is it a Repetitive Behavior?

Stimming can be thought of as a subset of repetitive movements.

It can involve things like:

  • Spinning
  • Flapping hands
  • Snapping or flicking fingers
  • Twirling
  • Rocking
  • Repeated verbalizations
  • Fiddling with objects

They’re categorized as a repetitive behavior because the person engages in them over and over again in a given time or place.

Does Stimming Behavior Have a Function?

The word “stim” is short for “self-stimulatory behavior.” Some Cleveland ABA therapists and other professionals shy away from categorizing the function as solely self-stimulatory, there may be intensified pressure on the person with the diagnosis to suppress them. And this may not be a good thing because, as people with autism will often say themselves, stimming can serve important functional purposes to their own mental health and physical well-being.

This is important to note because historically, parents, teachers, and others have labeled stimming behaviors as “disruptive” or “inappropriate.”

But there’s a growing body of evidence that stims can help people with autism relieve themselves of sensory overload. In turn, this helps them better cope with intense anxiety, avoid meltdowns, and express their emotions.

Others say that engaging in stimming helps them to generate or hang onto a sense of body awareness. It may also help them focus their concentration when they’re feeling otherwise overwhelmed. Further, it may be a means of communicating their emotional or mental state to others when using words to do so is difficult.

So forcing kids not to engage in stimming may be unhealthy, ultimately causing more harm than good.

Of course, different people on the spectrum may have different purposes for different stims – and it may even shift from time-to-time in the same individual, depending on what’s happening around them.

In some cases, it can be harmful to themselves or others. For instance, if a repetitive behavior stim involves banging their head against a wall, that can’t continue.

There is also, of course, the potential for social alienation or academic/professional consequences for engaging in stims.

Should I Be Encouraging or Suppressing My Child’s Stimming?

This answer to this question truly comes down to the behavior, the individual, and the setting.

Years ago, the common consensus was to eliminate these behaviors – sometimes in ways that were extreme (and often incredibly harmful) such as powerful antipsychotic drugs or physical interventions.

It’s really important for parents, teachers, Cleveland ABA therapists to come together as a team to discuss whether certain stimming behaviors truly need to be addressed, or whether there’s an opportunity for better education/awareness/accommodations in service of what’s best for the child.

When there is a repetitive behavior stim that appears to be disruptive or if it’s preventing the person from participating in meaningful activities, educational opportunities, or relationships, then we may want to start by analyzing the function of that behavior. From there, we can figure out if there’s a way to help them meet their needs or serve that function without impeding their everyday lives.

For example, let’s say the stim is spinning in circles and it’s preventing a child from participating in their preschool class instruction and it’s disrupting the other students. We study the “why” of the behavior, and determine it’s helping the child to soothe their anxiety when their in the classroom and feeling overstimulated. We may be able to suggest another calming action or behavior that they can engage in that is less disruptive. Sometimes, having regular movement breaks and sensory input can help reduce this anxiety/need for the stim in the first place.

In that scenario, we do not categorize the stim as “bad.” In fact, we recognize it’s serving an important purpose. We respect and meet the needs of the individual with an alternative that helps them to still engage in their daily lives and avoid adverse consequences to their education and peer relationships.

If you have questions about your child’s stimming or how to handle it, our dedicated Cleveland ABA therapists can help.

Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy to children in Brecksville-Broadview Heights, Cleveland, Akron, and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

Understanding Stimming: Repetitive Behaviors with a Purpose, Dec. 7, 2020, American Psychiatric Association

More Blog Entries:

5 To-Dos After Cleveland Autism Diagnosis, May 13, 2022, Cleveland ABA Therapy Blog

Cleveland ABA therapy

Finding the Function of Behavior: Cleveland ABA Therapy Insight

When it comes to the science of behavior, the first question our Cleveland ABA therapy team wants to have answered is: Why?

Every behavior has a function. It is finding out the function of behavior that allows us to formulate effective intervention strategies to help change it. For our Northeast Ohio behavior analysts, determining the function of behavior is – without question – one of the most essential parts of this job.

Parents and caretakers also may benefit a great deal when they understand why a behavior occurs. We teach parents basic strategies on how to do this, allowing them to troubleshoot in the moment. This is important because when we don’t know the true cause of a behavior and our response is reactive, we may in fact end up reinforcing that behavior, unintentionally.

Why is my child face down screaming bloody murder in the grocery store when all I did was take his fingers out of his mouth? Why won’t my child stop throwing his food onto the floor when I’ve begged, coaxed, and even yelled at him not to do that?

It’s key to understand that there is a reason behind all behavior. All behavior has a function. If the goal is a different response or outcome, we must find out why the behavior is occurring in the first place. We must also understand unintentional reinforcements. For example, if the function of a behavior is to gain mom & dad’s attention (which is a pretty common function), then mom & dad yelling or having some big response to a behavior has the exact opposite effect of what they intended. They are unintentionally reinforcing that behavior – and that is going to take some time to undo.

Cleveland ABA Therapy Team IDs Top 4 Behavior Catalysts

When it comes to motivation for behavior, there is no one-size-fits-all. That’s why we are behavior scientists. We use tried & true methods to test our theories and hypotheses. We carefully study the ABC’s of behavior (antecedent, behavior, and consequence). What happened just before the behavior? What was the behavior itself? What happened immediately after? Then we see if tweaking the antecedent and/or consequence has any bearing on the behavior. If it doesn’t, we can keep trying different strategies, or we may have to adjust our initial theory about the function of the behavior (i.e., maybe the goal isn’t attention-seeking, but rather sensory input).

At our Cleveland ABA therapy clinic, we’ve identified the top four behavior motivations that can help provide parents with a good starting point in their own analyses. They are:

Attention. This is probably the most common behavior motivator. Here, a child will engage in a certain behavior because it gains them attention. Young kids are going to be constantly looking to seek parents’ attention, but it might also be teachers, therapists, siblings, peers, etc. And bear in mind: Not all attention-seeking behavior is the same. A child may shout out of turn in preschool. They may kick their parent from the grocery store cart. They may run away (knowing mom or dad will run after them & catch them).

Escape. Children often engage in avoidance behavior as a means of getting out of unwanted situations. “Escape” could mean throwing a tantrum to get out of brushing teeth before bed. It could be throwing non-preferred foods off their plate and onto the floor. It could be bolting out the door and down the street. Parents have to be really careful with this one because a common “punishment” is time-out – but if the motivation is escape, they’re unintentionally reinforcing this behavior.

Access. The child may be engaging in a certain behavior to get access to a desired thing or activity. An example might be if they rip a toy from their sibling’s grip, simply because they wanted it. Doing so gave them access – and immediate gratification.

Automatic. We might also call this “sensory motivation.” The child engages in this behavior mainly because it feels good. For kids with autism, this could mean flapping their hands, banging their head, spinning in circles, etc. These can be some of the toughest behaviors to tackle because there often isn’t a good “consequence” for these. We may need to look closely at whether these are behaviors we truly need to address, or whether it is harmless stimming/self-soothing.

Our ABA therapy team uses evidence-based methods to help determine the child’s motivation, but also use positive reinforcement to help them to find more appropriate responses.

Therapy & Wellness Connection – your connection to a life without limitations – provides speech therapy to children in Akron, Cleveland, Brecksville-Broadview Heights and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

Observing Behavior Using A-B-C Data, By Dr. Cathy Pratt, BCBA-D and Melissa Dubie, M.S., Indiana Resource Center for Autism

More Blog Entries:

5 To-Dos After Cleveland Autism Diagnosis, May 13, 2022, Cleveland ABA Therapy Blog

Akron ADOS testing

Akron ADOS Testing – What to Expect

If a child is suspected of being on the autism spectrum (usually by a parent, doctor, or teacher), they will be referred for an ADOS test. Akron ADOS testing can be completed by professionals who are certified to conduct it. These can be psychiatrists, developmental pediatricians, and pediatric neurologists. Some Northeast Ohio therapy clinics also have staff trained to administer ADOS testing. Therapy & Wellness Connection offers ABA therapy after your child has undergone ADOS testing.

Autism spectrum disorder, or ASD, is a developmental disorder that impairs one’s ability to communicate and interact. It’s a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. It’s often accompanied by other things like sensory sensitivities, sleep disorders, gastrointestinal issues, seizures, and mental health difficulties like depression, anxiety, and attention issues. The U.S. Centers for Disease Control and Prevention reports 1 in 44 children in the U.S. is on the autism spectrum.

Akron ADOS Testing Akron ABA Therapy

Obtaining a formal diagnosis of autism is important for a few reasons. Firstly, we know that autism can be identified in kids as young as 18 months, though most diagnoses occur between the ages of 2 and 3. It has been proven that the earlier a child can receive intensive intervention therapies, the better their long-term prognosis in academics, social skills, etc.

Secondly, while our ABA therapy, speech therapy, occupational therapy, and physical therapy teams will treat children based on their symptoms, it’s difficult to get insurance to cover these services if there isn’t a clear, underlying medical reason. Paying for them out-of-pocket is often not an option for many families, so this is often the primary reason.

An ADOS test in and of itself will not be the deciding factor of whether a child is diagnosed with autism. It is, however, an important element that pediatric specialists will use to inform their diagnostic decision.

What is the ADOS Test?

If your child is scheduled for Akron ADOS testing, it’s important to know what exactly the ADOS test is.

ADOS is an acronym that stands for Autism Diagnostic Observation Schedule. It’s a standardized test that is semi-structured, designed to quantify the degree to which a child may be considered at-risk for autism spectrum disorder.

An ADOS test will analyze a child’s level of advancement in areas of:

  • Communication.
  • Cognitive function.
  • Social interaction.
  • Imaginative play.
  • Other behaviors/aspects that may be relevant to a diagnosis of autism spectrum disorder

ADOS is a little different than testing for conditions like Down syndrome or cerebral palsy, because there are no obvious physical traits or genetic markers that can definitively reveal whether a child has autism. It’s even more complicated by the fact that as a spectrum, autism is pretty vast. Two people may have entirely different symptoms, but both fall under the criteria of autism.

As it stands, the current Diagnostic and Statistical Manual of Mental health Disorders sets forth the criteria for psychiatrists, psychologists, pediatric neurologists, and pediatric behavior specialists analyzing whether an autism diagnosis is appropriate.

What Will Happen During Akron ADOS Testing?

Before beginning a formal evaluation, most practitioners will ask parents/caregivers to fill out a questionnaire. If the child is in school or daycare, that professional may also be asked to complete a questionnaire, to explain the behaviors they are seeing.

Some of these questionnaires cast a broad net – intended to identify lots of potential red flags. So children who are not autistic may be flagged, but the goal is to ensure they aren’t slipping through the cracks.

The more comprehensive evaluation will be tailored to the child’s age and skill level. Akron ADOS testing for young kids will be very play-based. Modules for older kids may be more conversation-based.

It’s not the sort of analysis where there is a right or wrong answer. What the tester is looking for is evidence of repetitive behaviors, social skills deficits, etc. Sometimes, it is as much about what the child doesn’t say as what they do say. For example, the evaluator may be looking at whether the child asks for help if they need it, whether they give others a chance to speak, whether they display joint attention to an object or focus, and whether they can follow along with changes of subject.

Often, parents will be asked not to be present for ADOS testing. At the very least, they may be asked to sit quietly in a corner of the room, not engaging their child. Parents can actually unintentionally skew the results of the test. An evaluator may ask the child to hand them the blue cup. They want to see whether the child can follow a simple, one step direction. Something as simple as eye contact from a parent toward the object can give the child clues as to what they are supposed to be doing. But the ADOs test provider wants to see what the child is able to do on their own – without any other hints or clues.

It’s important that when you schedule an ADOS test, you do so with someone who is not only credentialed, but experienced. The reason is there are a lot of subtleties that can arise in this testing. For example: Is the child not making eye contact because they are shy? Or is it a symptom of autism?

Most ADOS tests will also incorporate some cognitive testing. Lots of people on the autism spectrum are very bright, but they are more prone to learning disabilities and deficits. The examiner will be looking for information on how the child thinks – How do they organize and plan? How do they solve problems? What are their cognitive strengths and weaknesses? This can part of the foundation for developing an IEP (individualized education plan) once they reach school.

Experienced ADOS interviewers will often also include an interview with the child’s parent(s), gathering as much information as possible to help ensure their results accurately reflect the abilities and deficits of the child.

If you have questions

Therapy & Wellness Connection – your connection to a life without limitations – provides speech therapy to children in Akron, Cleveland, Brecksville-Broadview Heights and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

What Should an Evaluation for Autism Look Like? By Rachel Ehmke, Managing Editor, Child Mind Institute

More Blog Entries:

When Should Our Child Start ABA Therapy? Dec. 15, 2021, Akron ABA Therapy Blog

Cleveland ABA Therapy Strategies to Use at Home

Cleveland ABA therapy strategies to use at home

Parents are a key part of the puzzle when it comes to successful Cleveland ABA therapy for kids on the autism spectrum. Knowing how to work on the skills we target in therapy in a home setting is important for the sake of consistency, and helps those lessons to stick.

Applied Behavior Analysis, also known as ABA therapy, has been deemed the gold standard in autism treatment. It’s a branch of behavioral science that can be achieved either in-clinic or in-home by a trained therapist known as an RBT (registered behavior technician) and overseen by a Board-Certified Behavior Analyst, or BCBA for short.

It’s an evidence-based intervention predicated on the principles of behavior science, focusing on how people learn, behave, and change. A core foundation is what we call the “ABCs of Behavior.” That is, we study the antecedent, behavior, and then consequence – before determining what interventions will be most successful in addressing unexpected behaviors and promoting expected/helpful behaviors. Successful Cleveland ABA therapy helps improve kids’ quality of life, teaches them important life skills, and helps reduce disruptive behaviors.

As professionals, we’ve spent a great deal of time and dedication learning the science and strategies. That said, one of our key goals is to empower parents to implement similar tactics at home. Here, we detail a few of the basic strategies you can employ with your child across settings.

Positive Reinforcement

This is perhaps the most common strategy in ABA. Positive reinforcement is the idea that when something positive happens after a behavior (what we would refer to as the antecedent), it can have a positive impact on whether that behavior is likely to be repeated.

So a behavior followed by positive reinforcement is more likely to happen again – and continue happening.

Lots of parents use this strategy all the time with neurotypical kids. For instance, they do a chore, you reward them with an allowance. That motivates them to keep doing it.

ABA therapy Cleveland

With kids on the autism spectrum (or other conditions for which ABA therapy is prescribed), the reward usually needs to be more immediate, and perhaps more tangible. (Money is tangible, but its concept is a little abstract for some kids.) We may start small, especially for younger kids. Let’s say the LOVE blowing bubbles. If the goal is to get them to make a request for something, you immediately give them access to a few rounds of bubble-blowing after.

Depending on the targeted behavior and age/skill level of the child, there different reinforcement schedules we could choose from. These are:

  • Continuous schedule. The behavior is reinforced after every occurrence.
  • Fixed ratio. Behavior is reinforced after a certain number of occurrences (every 3, every 4, etc.)
  • Fixed interval. Behavior is reinforced after a certain amount of time (i.e., after 1 full week of expected behaviors).
  • Variable ratio. Behavior is enforced after varied number of occurrences (after one occurrence, then after four occurrences, then after two, etc.).
  • Variable interval. The behavior is enforced after a variable amount of time (after 5 minutes, then after 10 minutes, then after 2 minutes.)

You can discuss with your child’s ABA therapist what schedule they think would be most effective for targeting certain behaviors with your child.

Providing Prompts

Anytime you’re teaching your child something new, you can provide prompts. Lots of us do this naturally in parenting, but kids with autism and other conditions may need additional prompting to be successful.

There are many different kinds of prompts. For example, a physical prompt involves physically helping your child do something. A verbal prompt is telling your child something that will help them complete the task. If you provide a model prompt, you show them how to do it first. A visual prompt is a visual aid that helps your child complete the task. Gestural prompts are when you use body movements or gestures to help guide your child into completing something. Lastly, auditory prompts – like a stop watch or timer – that use noise can help support skill independence.

Cleveland behavior therapy kids autism

Some examples of prompts you can use at home:

  • Setting a timer to help your child transition from one activity to the next.
  • Providing your child with a visual schedule of the day’s routine, so they know what to expect.
  • Physically assisting your child with brushing their teeth.
  • Showing your child how to zip their coat.
  • Pointing to an object you want them to retrieve.

If you need some help with planning your prompts, our ABA therapy team can help.

Operant Extinction

This is the idea that a behavior that was previously reinforced (often unintentionally) can be decreased if we stop reinforcing it. Essentially, the goal is for your child to stop engaging in a certain behavior because they are no longer experiencing the same outcome as before. (Again, we’re focusing on changing the antecedent, or what happens immediately after the behavior.)

Keep in mind: All behavior is a form of communication. Your child communicates their wants, needs, and aversions with behavior. They may be trying to avoid certain non-preferred activities or foods. They may be wanting your attention. or they may be engaging in the behavior as a form of sensory input/avoidance. A behavior can be unintentionally reinforced when a child gets what they’re looking for by engaging in the behavior.

So let’s say a child has a temper tantrum that involves throwing themselves on the floor, screaming and crying. To quiet them down in a public place, you give them your phone. The child learns that engaging in screaming, crying, and laying on the floor, they are rewarded with game time. If you stop providing them with the phone when they engage in this behavior, eventually, the behavior will stop.

(Keep in mind, though: Temper tantrums are different than meltdowns, and may need to be approached a bit differently.)

Here’s another example. While seated in a grocery cart seat, your child kicks and hits you repeatedly. You get upset, use angry words and raise your voice. It continues to happen every time you go to the store. Eventually, you talk to your child’s ABA therapy team and determine the goal of this behavior is to get your attention. It doesn’t matter that the attention you provide is negative; you are still unintentionally reinforcing it. To achieve operant extinction, you must start to completely ignore this behavior. And then when your child is behaving in a way that is expected – lavish them with LOTS of attention and praise. By shifting the reward cycle, you can often change behavior.

Cleveland ABA Therapy Team Urges Consistency

The whole concept of rules and boundaries is based on the basics of behavioral science. In ABA, establishing rules – and then staying consistent – is imperative if you want to achieve better behavior.

Have a clear set of rules for each setting. These can start off very basic, such as “No hitting,” “No jumping on furniture.” But they can start to be more complex as your child progresses.

Break it down as much as needed. For example, it’s not just “house rules,” but “bathroom rules,” “bedtime rules,” “breakfast rules,” etc. Use visual schedules and auditory prompting, if need be. And then stay consistent. Kids who know what to expect are going to have an easier time behaving in a way that is expected.

If you have questions, our dedicated Cleveland ABA therapy team can help.

Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy to children in Brecksville-Broadview Heights, Cleveland, Akron, and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

Treatments and Intervention Services for Autism Spectrum Disorder, U.S. Centers for Disease Control and Prevention

More Blog Entries:

5 To-Dos After Cleveland Autism Diagnosis, May 13, 2022, ABA Therapy Cleveland Blog

Cleveland autism diagnosis

5 To-Dos After Cleveland Autism Diagnosis

Cleveland autism diagnosis

A Cleveland autism diagnosis can leave parents reeling – even when it’s something you’ve been expecting as you awaited the results of ADOS testing and other examinations. Sometimes, it can feel like something of a relief. You finally have answers. But there’s also the daunting next question: What now?

Parents face a lot of uncertainties, siblings may not understand (or may have much anxiety if they do), and the child who was diagnosed may not yet understand the implications – but can still sense shifts in emotional tone throughout the home.

Autism, more formally known as Autism Spectrum Disorder, or ASD, refers to a broad range of conditions characterized by difficulties with social skills, repetitive behaviors, speech, and non-verbal communication. The U.S. Centers for Disease Control and Prevention reports that autism affects 1 in 44 children in the U.S. today. Our dedicated team of speech therapists, ABA therapists, occupational therapists, and educators offers help to families in Cleveland, Brecksville, Broadview Heights, and Akron.

No. 1: Breathe

The very first thing to do after a Cleveland autism diagnosis is BREATHE. Autism is a lifelong condition – and that in itself can feel very intimidating as you contemplate your next steps. But know that in most cases, the symptoms can be managed. Behaviors can be managed with help. Your child can lead a long, healthy, meaningful, successful life.

You have already taken the very hardest step in all of this, which is seeking professional intervention when you recognized something wasn’t quite right. You persisted in pursuing answers – even when you knew the answers might pose challenges you might not feel ready to face. You did this because you love your child.

Now that they have an autism diagnosis, give yourself a few beats to catch your breath, acknowledge your own feelings, and prepare yourself for the next chapter. Your engagement and advocacy will be pivotal to your child’s success, and it’s important that you’re in a good mental/emotional space to do so. Online support groups through Facebook and other social media channels can be especially helpful as you embark on this journey.

No. 2: Explore Early Intervention

The next/first step is to get help. Your options may vary depending on your child’s age. Do not worry that your child may be too young. A child can receive a Cleveland autism diagnosis as young as 18 months, and early intervention therapies are strongly recommended to start before a child turns 3.

In Northeast Ohio, we have a program called Help Me Grow for infants and toddlers birth to age 3 with a medical diagnosis or developmental delay, as well as for families concerned about their child’s development. They help work on things like speech delays, social interaction help with other kids, etc.

Services and specialists may include:

  • occupational therapy
  • speech therapy
  • physical therapy
  • developmental specialist
  • early childhood mental health therapy
  • registered dietician
  • vision and hearing specialists

You may need to obtain a referral to early intervention from your pediatrician or pediatric specialist. In Cuyahoga County, it takes about 45 days from the referral to complete the eligibility, assessment, individual family service plan, and then finally the beginning of early intervention services. There has been something of a backlog since COVID, so it’s a good idea to get this process started as soon as possible.

Cleveland autism resources

No. 3: Start Looking at Private Therapy

Early intervention is provided as a public service. But children with autism can also benefit from private therapy services. In the beginning, the schedule of these services may be intensive, ultimately tapering off as they reach their goals and milestones.

Children with autism are often referred for a combination of therapy services, including:

  • Speech Therapy
  • Occupational Therapy
  • Applied Behavioral Analysis (also known as ABA or behavior therapy)

Therapy & Wellness Connection offers all of these – and more – and insurance covers most if not all of these services if your child has been diagnosed with autism. We can provide these services in-clinic, in-home, and sometimes in school or daycare. Some patients may be eligible to receive some of these services via teletherapy.

The key with these services is consistency. Intensive therapy, particularly early on, can feel a bit overwhelming when it’s 3-4 times a week (longer stretches with ABA therapy), but showing up and being actively engaged in the carryover is important.

If your child is school-age, the school should begin the process of drafting an IEP, or individualized education plan. If you find ultimately that your child’s school and IEP fail to serve their best interests, there are scholarships available to enroll them in private education, with teachers who will teach the way they learn. Therapy & Wellness Connection offers homeschooling and other education services with credentialed special teachers and intervention specialists.

No. 4: Engage With a Social Skills Group

Among the most significant deficits many kids on the autism spectrum face are communication and social skills. They’re going to need as much practice as they can – early and often. And it’s a lot of pressure to just put on a sibling or two. Joining a Cleveland social skills group for kids with autism can help them make significant strides.

We offer several different social skills groups, sorted by age, at our Brecksville clinic. These include:

  • Say-n-Play. This is an awesome group that focuses on social interactions and activities like crafts, songs, games, and books. It helps children with speech-language difficulties, but also following directions and engaging with others in a group setting.
  • OT Group. This focuses on zones of regulation, social interaction, and skills of daily life. We take fun “field trips,” play games, and work on group projects.
  • Thrive Social Center Courses. These include everything from learning social boundaries to getting along with friends to teens & technology, to young adult groups.

This extra support will help prepare kids for real-world scenarios and interactions, helping them make friends, stay safe, and be included.

No. 5: Learn to Listen Without Your Ears.

If your child has received a Cleveland autism diagnosis and is non-verbal or speech-delayed, it can be very frustrating to know what they want, what they don’t want, how you can help, and how to parent them. But just because they aren’t talking doesn’t mean they aren’t communicating. Remember that behavior itself is a form of communication, and kids on the spectrum may be engaging in “unexpected” behaviors to communicate wants, needs, or aversions.

ABA Therapy is extremely helpful in addressing unexpected behaviors and promoting those that are expected and helpful. Speech therapy can help with non-verbal communication, articulation, and social pragmatics. Occupational therapy can help kids tackle critical life skills like self-regulation, measuring the size of a problem, diversifying their diet, self-care, etc.

But in the meantime, recognize that just because they aren’t talking doesn’t mean they don’t have anything to say. You may be your child’s voice for the foreseeable future. It’s important to try your best to engage them at every opportunity, and understand what’s NOT being said.

Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy to children in Brecksville-Broadview Heights, Cleveland, Akron, and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

What is Autism? AutismSpeaks.com

More Blog Entries:

Cleveland ABA Therapy Strategies, May 5, 2022, Cleveland Autism Treatment Blog

Cleveland ABA therapy

Cleveland ABA Therapy Strategies

Cleveland ABA therapy

Approaches to Cleveland ABA therapy for children with autism can be varied depending on the provider. If your child is on the spectrum and you’ve been referred to behavior therapy by your pediatric specialist, it’s important to talk to the behavior therapy provider not only about the goals they have for your child, but the strategies they employ.

At Therapy & Wellness Connection, our strategies may need to be adapted for each child, but they primarily involve positive reinforcement.

The goal of our Cleveland ABA therapy services is to provide kids on the autism spectrum with the spills they’re going to need to be independent in all types of environments. We help lay the foundation, the building blocks, to help them learn – which in turn is going to help them not only function, but fully engage – whether that’s at home, in school, or pursuing their passions as they get older.”

-Jaclyn McClymont, Therapy & Wellness Connection Owner & Founder

The basics of ABA usually involve things like:

  • Learning to make requests
  • Waiting a reasonable amount of time to have that request fulfilled
  • Transitioning from one activity to another
  • Completing tasks
  • Accepting “No”
  • Following directions
  • Mastering skills relating to health, safety, and important tasks needed for learning

Typically, we start with a functional behavior assessment, which helps us determine which behaviors we want to target for extinction, and which we want to promote/encourage.

Wherever possible, our Cleveland ABA therapy team will work to ensure that the “why” of what we’re learning makes sense to the child. So if the goal is for them to be able to put on their own jacket, we avoid initiating that task randomly. We do it, for example, to prepare to go for a walk or some other task.

We offer our services both in-home and in-clinic. In both cases, we try to use as many real-world examples as possible. So for example, if we’re trying to teach a child how to get ready to eat lunch, we want to give them opportunities to do things like choose their spoon from a kitchen drawer, as opposed to pointing to a flashcard of a spoon.

Understanding Antecedent-Based Interventions

One technique we frequently employ in our Cleveland ABA therapy sessions involve antecedent-based interventions.

To explain how this works, it’s helpful to understand how ABA therapy views learning. That is, we focus on a three-stage process referred to as the ABCs of behavior (Antecedent –> Behavior –> Consequence). The antecedent looks at what happens immediately before the behavior, what triggers it. Then we analyze the behavior itself. From there we look at the consequence, or what happens immediately after that may be enforcing it (intentionally or unintentionally).

For example, let’s say your child has major meltdowns while you’re making dinner. The antecedent may be their own hunger. The behavior is their meltdown. This may be unintentionally reinforced by a consequence of giving them a high-sugar snack, right before dinner.

As ABA therapists, we look at whether the behavior can be modified by altering the antecedent or consequence. We may modify the environment to reduce triggers. We may identify when bodily needs are triggering the behavior (hunger, fatigue, overstimulation) and work to address those. For example, a child who is overstimulated may need a movement break/exercise/quiet time at certain times of the day or when certain things are happening – to be able to better cope and avoid meltdowns.

In addition to modifying the child’s learning environment, another antecedent-based intervention is to give a child choices. Rather than asking a child to complete a worksheet, we may give them a choice: Worksheet A or Worksheet B. Having a choice helps children to feel more confident and in-control – and increases the odds they’ll complete the task, rather than defiantly saying no.

Finally, we may engage children using motivating items, such as a toy, a favorite food, or a game/activity.

Consequence-Based Interventions and Extinction

And we also look at altering the consequences, or reinforcement. Parents and other caregivers sometimes unintentionally reinforce unexpected behavior with a “consequence” like time out or verbal admonishment that actually gives the child what they want (a break, attention, etc.). They may not necessarily see it as “negative,” even if it’s carried out in that context.

Redirection is one that we use frequently. It’s when we distract a child from a problem behavior, drawing their attention to a more appropriate solution/behavior.

Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy to children in Brecksville-Broadview Heights, Cleveland, Akron, and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

Applied Behavior Analysis, Autism, and Occupational Therapy: A Search for Understanding, July/August 2016, The American Journal of Occupational Therapy

More Blog Entries:

ABA Therapy Explainer: What’s a Functional Behavior Assessment? March 9, 2022, Cleveland ABA Therapy Blog

Brecksville ABA therapists

Brecksville ABA Therapists Offer “Time-Out” Alternatives

As Brecksville ABA therapists, our focus is on the study of behavior. When it comes to children with autism and other conditions, the interest is not only on what the challenging behavior is, but what the motivation – or function – is and how caregivers may be unintentionally reinforcing it. This brings us to the ever-popular approach of time-out.

You’re almost certainly familiar with the “time-out” strategy because it’s very popular. As explained by the CDC, timeout is when a child is removed from where the “misbehavior” occurred – deprived of fun, attention, or some other desired activity. Time-out is used for things like breaking a rule or not following a direction after a warning. It’s effective for lots of neurotypical kids because time-out is boring, and kids don’t usually like to be bored.

However, timeout isn’t effective for addressing all behaviors, and it’s may not be effective for every child. For children with autism spectrum disorder or developmental delay or some other disability, time-out can provide a safe space for them to work on calming themselves. However, it’s not going to be effective if:

  • The child is aggressive or using self-injuring behavior.
  • The child’s goal is to avoid the activity or interaction with others.

In both of these cases, time-out might inadvertently reinforce the challenging behavior. In the case of self-injurious behavior, putting them in a space alone isn’t likely to stop it. If the child’s goal is to avoid interaction or a non-preferred activity, time-out actually gives them what they want. In effect, adults may be inadvertently giving them a reason to engage in challenging behaviors to achieve the goal of getting in time-out.