Cleveland ABA therapy
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.
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.
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 ABA Therapy Strategies
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
ABA Therapy Explainer: What’s a Functional Behavior Assessment?
When your child starts ABA therapy, there are a lot of vocabulary words and acronyms that seem to get thrown around, and it can take some type to truly get a grasp on it all. Functional Behavior Assessment, or FBA, is the one we’re going to focus on here.
A Functional Behavior Assessment is one of the primary ways our behavior therapy team works to identify a certain problem behavior, and then we develop a plan to address them – ultimately eliminating them or at least reducing them to a point they aren’t so prevalent.
Going through the process step-by-step helps our Cleveland ABA therapy team to get to the source of the behaviors so that we can start introducing replacements. The problem with trying to tackle a problem behavior without an FBA is that then you lack the “why.” WHY were they engaging in that behavior in the first place? Every behavior has a function. Trying to effect the extinction of a behavior without first figuring out its function is going to create a gaping opportunity other difficult behaviors to take root in its place. An FBA helps us figure it out first.
FBAs can be used in IEPs or as part of an ABA program. We only initiate them when the behavior has become an impediment. We’ll be looking at it as a team – in collaboration with parents too – to assess whether it’s urgent (is there a risk of harm to self or others?), whether there’s an underlying medical reason, whether it’s cyclical, and if it appears to be new or if this is a long-standing issue that has maybe just gotten worse. Finally, we want to know if this is something that is happening on a consistent basis. If it was a random, one-off reaction to a substantial – and uncommon – change in the environment, we probably don’t need to develop a plan to treat that, though we may note it. In cases where there may be multiple unexpected and detrimental behaviors, we’re likely to target them one at a time, beginning with the one likely to have the most significant adverse outcomes.
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.
Brecksville ABA Therapists’ Tips on Navigating Thanksgiving
Lots of families look forward to celebrating the holidays each year, with Thanksgiving being a particular favorite. But as our Brecksville ABA therapists understand, parents of children on the autism spectrum may be worried that such celebrations are far outside their kids’ comfort zones. After all, the goings-on are seemingly chaotic, and many of the faces, smells, and tastes are not part of the daily routine they’re used to.
The good news is that with some preparation, it is possible for everyone to enjoy these gatherings.
How Our Brecksville ABA Therapists Teach Flexibility
Flexibility is the quality of bending without being easily broken. Our Brecksville ABA therapists know that for kids on the autism spectrum, being emotionally flexible is an incredibly difficult – but critical – skill for success.
It’s not just kids with autism. Flexibility doesn’t come naturally for lots of people. Many of us are creatures of habit. Flexibility is something that must be learned. But it can be much harder for those on the spectrum to master this. In fact, autism is defined as being characterized by restricted, repetitive patterns of behavior, interests, or activities. It’s part of the diagnostic criteria for autism, and it’s manifested with insistence on inflexible adherence to routines, sameness, and ritualistic patterns of verbal/nonverbal behavior. Even the smallest changes can trigger a meltdown.
But why is this so important? Because change is a part of life. Realistically, no one can indefinitely eat the exact same thing, watch the exact same show, or be in the exact same place with the exact same people all day every day. And to whatever extent you may be able to help ensure continuity of certain patterns or routines, our ABA therapists recognize that helping kids on the spectrum learn to adjust to change will ultimately lead to them being happier, healthier, and more independent.
How Do Brecksville ABA Therapists Teach Flexibility?
Because rigidity is a characteristic of autism, intervening and treating it must be done very carefully. We’re not looking here to turn an inflexible person into a flexible one. What we want is to help each child learn to better adapt to a world that is ever-changing. The world is never going to be constant. There will be things outside of their control, and it’s important that they learn to cope when that happens.
Unlike many other life skills, flexibility is a bit more of an abstract concept. As such, it can be a bit tougher to teach. Our ABA therapy team focuses on stretching their tolerance to routine changes and then providing consistent, positive reinforcement where see it.
For instance, a child may love playing a certain game at therapy. We might start with testing their insistence to always play as the same game piece. Anytime they show increased flexibility, we reward that positively. We might eventually move to playing a different game altogether. The goal is for the child to ultimately adjust more easily (and without challenging behaviors) to unexpected changes in their routine. They can maintain a sense of assertiveness about what they like or what they want while still learning to calmly accept other changes. In other words: Greater flexibility.
Our ABA team also works with many of our clients in the real world, to teach them flexibility strategies to better tolerate change where they are most likely to encounter it.
It’s important that we’re not just tearing them away from rituals and patterns. We are first looking at behaviors we want to replace. That often means early on teaching them to request what they want, to wait for what they want, to self-manage big emotions (namely, anger and disappointment) and to problem solve. We do all this by intentionally, systematically introducing change in ways that are controlled – and then teaching them these skills one by one over time.
It’s important that when they are triggered, that we teach them a workable “plan of action.” This is going to highly depend on the individual, but the gist is to empathize (this is important) and then give them tools to help them de-escalate. This could be deep breathing, it could be squeezing a stress ball, it could taking a break. It’s important when we’re teaching flexibility to remind them that even when situations do shift unexpectedly, there are still things that are unchanged or that they can control. Empowering them to focus on those can go a long way toward improving flexibility in tolerating the larger changes occurring.
Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy to children in Cleveland, Brecksville-Broadview Heights, Akron and surrounding communities. We also offer summer camp, day programs, homeschooling, alternative schooling, virtual therapy and education, vocational counseling and more. Call us at (330) 748-4807 or send us an email.
Additional Resources:
Signs and Symptoms of Autism Spectrum Disorders, U.S. Centers for Disease Control and Prevention
More Blog Entries:
ABA Therapists: Helping Your Child With Autism Transition Back-to-School, Aug. 12, 2021, Brecksville ABA Therapists Blog
Cleveland ABA Therapy Insight: Helping Your Child Wear a Face Mask
Wearing a mask has become required in many stores, restaurants, public event sites and schools. But complying with these mandates can be very difficult for children with disabilities and/or sensory processing needs. But our Cleveland ABA therapy team knows that doesn’t mean they cannot learn to overcome these aversions, particularly when it is a public health issue.
School districts across Ohio have various degrees of restrictions (some remain closed with only virtual school provided, others give parents the option to participate in virtual or in-person schooling and some are fully open). But just recently, the CDC released a series of guidelines for what it will take to safely re-open schools. As The New York Times reports, “the point of most agreement (among pediatric experts) was requiring masks for everyone: students, teachers, administrators and other staff. All respondents said universal masking was important, and many said it was a simple solution that made the need for other preconditions to opening less essential.”
If your child struggles with mask-wearing, our Cleveland ABA therapy team can help by incorporating it into our sessions, little-by-little, with positive reinforcement. But there are also ways you as a parent can help your child with this as well.
Study: Autism Diagnosed Later in Black Children
It’s well-established that racial disparity exists in numerous aspects of U.S. healthcare, with higher rates of illness and infirmity and lower rates of insurance coverage and quality care. Now, our Cleveland ABA therapists have learned of a new study published in the journal Pediatrics that found Black Americans are diagnosed with autism spectrum disorder at a much later stage than their White counterparts. In turn what this means is they are missing out on essential early intervention treatment that is critical to helping them overcome significant social and academic challenges in life.
Important to note: It’s the parents delaying the diagnosis, according to study authors.
“There’s something going on in the system,” said Dr. Daniel Geschwind, professor of neurology at the University of California and director of the Center for Autism Research and Treatment. In the study, Black parents reportedly noticed something was “not quite right” early on and sought medical help – and had insurance to cover evaluations and treatment. Even so, approximately 4 in 10 had to see a medical provider numerous times before their child received an autism diagnosis. Our ABA therapists know that getting appointments with specialists who can give a diagnosis like that can take well over 6 months each. (And lack of access to the kind of professionals qualified to make an autism diagnosis was specifically listed as one of the factors contributing to delay for about one-third of Black children ultimately diagnosed.)
Study: Early Intervention ABA Therapy for Children With Autism is Critical
An extensive clinical report on autism spectrum disorder released by the American Academy of Pediatrics summarizes more than a dozen years of research – and concludes what our Akron ABA therapy team has been preaching for years: Early intervention is key.
The analysis, which lists a huge source of references and clinical findings over the years, also officially scraps the diagnoses of Asperger’s syndrome and pervasive developmental disorder and puts all children with these diagnostic characteristics under the umbrella of “autism spectrum disorder,” or ASD for short. Symptoms (as you may be well aware) include:
- Difficulties with conversation
- Trouble with nonverbal communication
- Challenges reading social cues and relationships
- Restricted behavior patterns
- Repetitive movements
- Sensory differences
- Fixated interests
- Rigid routines
The key point made, however, was that we have an increased understanding and awareness of conditions that often occur simultaneously with autism, which has led to more planning and support. Additionally, there has been a greater emphasis on early diagnosis and referral for treatment, such as ABA therapy, even when ASD is suspected but not yet confirmed. The earlier the treatment begins, the better outcomes are recorded.
Therapy & Wellness Connection Teams With Augment Therapy
Therapy and Wellness Connection in Brecksville has teamed with Cleveland-based virtual therapy provider, Augment Therapy to provide our patients with high-quality speech, occupational, ABA and physical therapy online.
Families can set up this service through their television. It uses augmented reality programming (think Pokemon GO) to make exercise and engagement fun. The software is equipped with a camera that can capture not only the child’s image but movements too. These games on screen can be used to help children interact with cartoon characters and other features, allowing them to earn badges for reaching certain goals. 
It’s a prime tool in any circumstance, but especially effective as social distancing guidelines remain in place. With the tools and software provided by Augment Therapy, we’re able to continue teaching social and emotional regulation and participation in one of our many social skills groups.
Inspired by the way Pokemon GO motivated so many kids to become active, she began brainstorming a similar program that could motivate her patients to move, communicate and push themselves to their highest potential.
Supplement to In-Clinic Speech, ABA, Occupational and Physical Therapy
Augment Therapy has been valuable at a time when teletherapy services have become a necessity due to the ongoing pandemic. But long-term, it will be an excellent supplement to our in-clinic and therapy services Therapy and Wellness Connection.
When kids are having fun, they’re motivated to stay the course. Virtual, interactive games can accomplish this. For them, it’s not “doing therapy.” It’s playing a game. Yet it keeps them engaged with the therapist and other children and focused on their goals. Ultimately, allows them to achieve faster results that are more likely to “stick.”
Some of the benefits as outlined by Augment Therapy:
- Improves adherence. This refers to how closely a child follows the prescribed moves with good frequency and consistency.
- Use in home and in clinic. It has applications not just for therapists but teachers and parents too.
- Ease of use. Basically, you just plug in the software and play it. The setup time is minimal.
- Portable technology. The hardware itself is small, so even if you’re traveling or otherwise not at home, it can still be used.
- Does not require wearable devices. Lots of our patients have sensory issues, so wearing a technology device isn’t comfortable or practical. The Augment Therapy technology does not require it.
- Encourages social interaction. It can be played by more than one child at a time, promoting social skills as well as physical movement.
- Makes therapy and exercising fun! What kid doesn’t love video games? The difference between this and other movement games is that it focuses on engagement as much as movement.
Pilot programs were launched at the Cleveland Clinic and Rainbow Babies & Children’s Hospital. The technology also earned a sponsorship from MetroHealth after securing an award at the Medical Capital Innovation Competition.
Anything that can improve accessibility, participation and progress for children with special needs is something we’re eager to utilize, and we’re excited to offer this new service to our patients.
Therapy & Wellness Connection – your connection to a life without limitations – provides speech, occupational, ABA and physical therapy to children in Cleveland, Brecksville-Broadview Heights, 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:
Cleveland-based Augment Therapy is making physical therapy fun for kids via augmented reality, Aug. 24, 2019, By Ilona Westfall, FreshWaterCleveland.com
More Blog Entries:
5 Ways Our Akron Physical Therapy Helps Children With Down Syndrome, Sept. 28, 2019, Cleveland Physical Therapy Blog