Cleveland ABA therapy
How Our Akron ABA Therapists Work With Occupational Therapists to Provide Kids Optimal Care
When it comes to treating a child with developmental delays, disabilities, or injuries, it’s important to keep in mind that a child is a whole person. What we mean by that is that when we’re treating a child with complex needs or conditions, it would be easy for therapists in separate disciplines to focus only on the symptoms/skills they specifically are treating. But a “whole child” approach taken by our Akron ABA therapists, occupational therapists, and speech therapists considers that these systems are all interconnected – and we can make faster, more meaningful progress when we collaborate and work together.
ABA therapy (applied behavioral analysis) is an evidence-based therapy that is utilized to treat children with autism and certain other conditions with a focus on social communication, disruptive/harmful behaviors, motor skills, and more. The general thinking is that whenever a behavior is followed by something of value (in a sense, rewarded), it’s more likely to be repeated. That works both ways. Behavior that is unhelpful or dangerous can be unintentionally “rewarded” by certain outcomes (attention, avoidance, etc.). By the same token, ABA looks at the child’s motivation behind the targeted behavior and then seeks to alter the consequence, depriving them of the “reward” for unhelpful behaviors while rewarding those behaviors that are helpful/expected.
Occupational therapy, meanwhile, helps individuals achieve specific goals that involve engage in meaningful activities of daily living. That could mean anything from teeth brushing to handwriting to avoiding major meltdowns when moving from one activity to the next.
When ABA and OT professionals work together in a clinical setting, it improves the child’s overall success. therapists are able to be in constant communication with those in other disciplines about the child’s progress, methods that aren’t working, cross-promoting skills that are being targeted in both disciplines, and each providing useful strategies that the other finds most effective.
Every child’s treatment plan at Therapy & Wellness Connection is tailored to that individual, with a focus on how we can lay the foundation needed to help them build the skills necessary to succeed in everyday activities – from self-care to school to making new friends to learning how to regulate their own emotions. When both occupational therapists and ABA therapists work together (or at least, coordinate their strategies), they can each help reinforce the lessons the other is trying to teach. Both are most effective when provided in a way that is playful in an environment that is both safe and fun.
Both disciplines approach therapy with similar goals and methods. For example, occupational therapists will break down mechanical processes of certain tasks so that the child has an easier time correcting their current approach (or developing a new skill) so that they can ultimately achieve their goal. In behavior therapy, Akron ABA therapists break down each task into a smaller steps, one-at-a-time.
Both work to address sensory processing disorders in similar ways as well. A person with sensory processing issues may have extreme aversions (or penchants for) certain sensory stimuli – lights, sounds, tactile pressure, textures, tastes, crowds, etc. This can manifest itself in different ways.
For example, a child who has a major sensitivity to lights and sounds may have a really difficult time in a grocery store. Akron ABA therapists will look at the behavior (a meltdown) and try to determine, “What is the motivation?” In this case, perhaps it is avoidance. The meltdown gets them out of the bright, loud environment. They then look to see how they can alter the antecedent (what happens right before) and the consequence (what happens right after) to modify or extinct the behavior. In this situation, they may see whether a visual schedule (helping them know exactly what to expect and for how long) or possibly some sort of adaptation (headphones, sunglasses, etc.) may help avoid the meltdown. Alternatively, they may initiate a positive reinforcer for the child engaging in short periods of time in bright or louder environments, gradually building up their tolerance level – and empowering them to communicate when a situation is becoming too overwhelming and they need a break.
Similarly in occupational therapy, the therapist will use a sensory integration approach to help kids gradually desensitize (or learn to better “read” the sensory input they are receiving) to certain stimuli. It’s done of a period of weeks, months, or even years, little-by-little. OTs also work toward helping these kids be able to advocate for themselves and more effectively convey when something is uncomfortable, painful, or difficult. When OTs and ABA therapists collaborate, they can each reinforce the goals of the other with the same child.
Given that so many children with autism spectrum disorder have both behavioral and sensory issues, it makes a lot of sense for us to initiate a cross-disciplinary approach that will set the stage for our kids to be successful and have the highest quality of life possible.
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, Psychology Today
More Blog Entries:
How Long Will My Child Need to Be in Cleveland ABA Therapy? Dec. 23, 2022, Akron ABA Therapists’ Blog
What Makes Akron ABA Therapy Effective for Kids With Autism?
Providers of Akron ABA therapy understand well why it’s considered the gold standard for treatment for children with autism spectrum disorder (as well as a few other conditions like Down syndrome). But there are many schools of thought when it comes to this relatively newer practice area, so it’s perfectly understandable that parents and caregivers would ask, “What makes ABA therapy so effective?”
We should start by pointing out the obvious: People on the autism spectrum tend to process information a bit differently than others who are considered “neurotypical.” Autism is considered a developmental disability associated with differences when it comes to learning, moving, or paying attention, as well as challenges with social communication, sensory processing, and variations in routine. It’s a broad spectrum, so not every child or challenge is the same, and it can also vary depending on the environment.
Akron ABA therapy – applied behavioral analysis – is an approach to treatment rooted in the proven scientific methodologies of respondent and operant conditioning with the goal of altering behaviors of social significance. That’s a mouthful, but basically, it’s trained behavior specialists using a formulaic approach to studying behaviors that may be holding the child back in life, and determining how we might help them gradually let go of those by using one-on-one positive reinforcement over a period of weeks, months, or years.
The goal is not to change the child. We accept kids with autism as they are. What we strive to do is help them more effectively navigate the world around them.
ABA often focuses on skills that are part of independence and success in everyday life. It will vary depending on the child, their age, and how their challenges are impeding their independence and quality of life. These can include things like:
- Extreme sensitivity to certain sensory stimuli that can make it tough to carry out basic grooming.
- Intense fixation/focus on things to the extent that it impedes social engagement.
- Stringent reliance on routines that can impede the ability to transition from one thing to the next without major outbursts.
- Inability to focus long enough to benefit from classroom instruction, even in a modified classroom.
Behavior technicians, who are supervised by board-certified behavior analysts, may work on things like teeth brushing, eating a variety of foods, getting dressed, improvement of tactile tolerance/sensitivity, self-awareness and understanding “the size of a problem,” having conversations, making friends, reading emotions, advocating for their needs/wants, etc. If issues like self-harm or elopement are a concern, we can help formulate strategies to help reduce those occurrence or severity.
This is done by breaking down these larger skills into smaller, more manageable steps.
This all probably seems quite serious, but one of the reasons our Akron ABA therapy approach is so effective is because it is play-based. There’s a ton of research to back this, and the crux of it is: Kids remember the skills they learn when it’s fun. The positive reinforcements are child-led so that it’s always engaging. If they’re interested in music or certain characters or animals or toys – we try to incorporate those as much as possible. It doesn’t mean every day is easy breezy or there are never tough moments. But patients and therapists form a trust over time that ensures the child feels safe and respected and heard – and happy – while they’re working on these skills.
Lastly, the most effective pediatric ABA therapy doesn’t start and end with the child. The best programs are those that incorporate the concerns, ideas, and feedback of parents, other caregivers, teachers, doctors, etc. Ultimately, we want the skills being taught to carry over across environments – whether that’s at home, school, worship, community outings, and just being out in the real world. We can help parents and other stakeholders by providing strategies to apply when certain challenges arise (role play, modeling, redirection, etc.) so that there is consistency across environments. That is ultimately what is going to help the child absorb the lessons we’re imparting faster.
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:
More Blog Entries:
How Long Will My Child Need to Be in Cleveland ABA Therapy? Dec. 23, 2022, Akron ABA Therapy Blog
How Long Will My Child Need to Be in Cleveland ABA Therapy?
No two children on the autism spectrum are the same, In turn, the methods, intensity, and duration of the Cleveland ABA therapy they receive will be specifically tailored to the individual. That said, we know many parents want to know – at least roughly – how long their child is going to need therapy. Rather than outline a set number of hours or months or years, we point to specific goal posts – the biggest being an indicator of their functional ability and independence in everyday tasks.
Applied behavior analysis (ABA) is recognized as an effective treatment for kids on the autism spectrum, and sometimes those with other conditions like ADHD, oppositional defiant disorder, obsessive-compulsive disorder, Down syndrome, etc.
Most kids with autism will start ABA therapy sometime between the ages of 2 and 6 – with doctors and Cleveland ABA therapy providers agreeing that the earlier we start, the better. But as for how long it’s going to last, there is no magic number. What we can say unequivocally is that both intensity and duration (i.e., “the dosage”) of therapy are significant predictors of how well kids master their learning objectives.
This is well-established, but just as an example, a study published in 2017 in the peer-reviewed journal Translational Psychiatry examined the effectiveness of ABA therapy in varying durations for nearly 1,500 children ranging from age 18 months to 12 years, as measured by their mastery of skills ranging from social communication to self-regulation. The study found that both intensity and duration of therapy was positively correlated with better long-term outcomes in mastered learning objectives in areas like language, academics, adaptive behavior, and self-care.
Of course, it’s not expected that a child will receive behavior therapy indefinitely.
On average, it’s safe to say kids just starting Cleveland ABA therapy will receive anywhere from 20 to 40 hours weekly. The exact amount depends on things like the child’s age, condition severity, insurance coverage, parental ability, etc. This amount can be naturally reduced – or increased – over time as needed to ensure the child is receiving what they need to make progress on their goals.
We often start at a high intensity level – particularly during the first couple of years – and then taper off as the child gradually masters certain skills – sustainably and across different environments.
Some indicators we look for when assessing whether to reduce or discontinue ABA therapy are things like:
- Confidence in the child’s stage of functioning and independence for their age.
- The child is learning from the environment without the need for direct instruction.
- Parents and teachers are able to manage and reduce problem behaviors without additional support of a behavior therapist.
- The child is likely to benefit from a different educational environment (that isn’t one-on-one).
- Key goals have been met, and target skills mastered.
- The child is able to generalize their skills to different environments.
- New skills are acquired and mastered without requiring direct intervention and instruction.
Ending ABA therapy is often a major transition for kids, teens, and young adults. Our team works with parents, teachers, and others to make that transition as smooth and successful as possible.
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:
An evaluation of the effects of intensity and duration on outcomes across treatment domains for children with autism spectrum disorder, September 2017, Translational Psychiatry
More Blog Entries:
Cleveland ABA Therapists Explain Our Aim for Generalization of Skills, Nov. 2, 2022, Northeast Ohio ABA Therapy Blog
Akron ABA Therapist on Responding to Difficult Behaviors of Child With Autism
One of the most significant challenges for parents of a child with autism is concern for their child’s well-being when difficult behaviors that are aggressive, self-injurious or socially isolating. As an Akron ABA therapist can explain, there is no one-size-fits-all “right way” to respond to difficult behaviors. It’s important to carefully look at what may be motivating the child to engage in this behavior and also what occurs right after that could be unintentionally reinforcing it.
Understanding the “why” is key to being prepared with a better response – one that involves keeping the child and others safe, and incorporates strategies to help reduce future occurrences and reinforce more appropriate means of communication.
Some of the difficult behaviors commonly reported by parents of children on the autism spectrum:
- Scratching
- Biting
- Kicking
- Headbanging
- Face-slapping
- Hair-pulling
- Excessive scratching or rubbing
- Refusal to cooperate
- Screaming and yelling
- Throwing things
In a survey of 2,300+ published in the journal Pediatric Reports, roughly 40 percent of individuals on the autism spectrum currently or in the past have engaged in both aggressive and self-injurious behavior. The duration, severity, and frequency of these behaviors vary across the autism spectrum.
Why Kids With ASD Engage in Challenging Behaviors
It’s important to point out that usually, the child is not intentionally trying to test your patience or hurt anyone. And this is why “punishment” isn’t usually the best way to handle it because it’s not a matter of being “bad” or “spoiled” (no matter what kind of snide remarks you may hear from others if you’re unfortunate enough to be dealing with an episode in a public space).
A fair amount of research over the last five decades has revealed that comorbidities are a significant contributing factor in such behaviors. One of the most commonly cited comorbidities associated with these behaviors is impaired interoception, which is when a person has trouble perceiving their own internal body signals. (This condition isn’t unique to people on the spectrum, but it is fairly common among them.)
As an Akron ABA therapist can tell you, all behavior – at the core – is a form of communication. In ABA, we work to alter behavioral outcomes by studying the triggers and consequences/rewards and then consistently modifying one or both of those. But when issues with interoception are part of the “why” for the behavior, it can be tougher because the behavior itself is intrinsically physically rewarding, providing a measure of sensory input or relief.
Other possible behavior triggers include:
- Transitions
- Sudden or unexpected changes (in plans, activities, expectations, etc.)
- Frustration or anxiety
- Poor social and communication skills
- Difficulty focusing
- Mental and/or physical fatigue
- Executive functioning trouble
When you know this “why,” you can start looking at ways to reduce the chances of a trigger, as well as having a “toolbox” handy to respond quickly and effectively.
Addressing the Antecedent
In ABA, the antecedent is the first element of the “ABC’s of behavior science.” (The others are behavior and consequence.) The antecedent is the “trigger” or what happens right before the behavior occurs. Because kids with autism can’t always effectively express exactly what it is that they need or that’s causing them stress/pain/discomfort, etc., we have to carefully look for patterns of behavior to determine the specifics of what’s setting them off.
Armed with knowledge of the underlying issue, you can:
- Have a plan. You know your child struggles with transitions. You can help reduce this difficulty (and the odds of a meltdown) by preparing them with verbal and visual cues, timers, social stories, etc. so that they don’t feel so “taken off guard” when they must move from one activity to the next.
- Adjust the environment. Your child can still have meaningful or necessary experiences without experiencing them the exact same way as everyone else. Adaptations to account for sensory overload (headphones, sunglasses, chewable jewelry, etc.) can go a long way. Other adaptations can help ensure the environment is one that allows for engagement that is both calm and safe.
- Be picky about events. If your child struggles mightily with crowds, a theme park vacation may not be the best idea. Or if you do decide to go, perhaps limit the amount of time spent or distance traveled in a single go. Another example might be a child’s birthday party. If you don’t want to skip it entirely, maybe come early or later and only stay for a certain period of time.
- Have tools ready. Come prepared with tools to help them cope if they do start to feel overwhelmed. These can include fidget toys, electronic device with a favorite game app, “heavy work” exercises, etc.
- Give them choices. Providing the child with a sense of control can go a long way toward helping reduce challenging behaviors. You aren’t just telling them what to do and expecting they will, but instead giving them a choice about how to engage. For example, not doing homework may not be an option – but they can choose to either do it at their own desk vs. the kitchen table, or they can choose to do it alone vs. with parent helping.
- Designate safe spots. If you know certain places or scenarios are tough for your child, figure out in advance where they or both of you can go to self-regulate before continuing.
Adjusting the “Consequence”
The word consequence has a negative connotation, but that’s not necessarily what we mean here. It is simply: What happens immediately after the behavior? What is the child getting in return for their behavior? Is there a way to alter the consequence so that the child no longer finds engaging in that behavior to be an effective means of accessing that outcome?
When you work with an Akron ABA therapist, you’ll find the goal is to focus on supporting behaviors that are safe, productive, and boost the child’s confidence, while not supporting those that are harmful or socially isolating.
One approach that’s often effective when we’re trying to “extinct” a problem behavior is to avoid drawing attention to it. That often seems counterintuitive to many parents at first – because your instinct is to immediately tell them to stop, etc. But as long as the behavior isn’t dangerous, ignoring it entirely can be effective – especially if the behavior is attention-seeking. At first, this approach may actually trigger an increase in the behavior (referred to as a “behavioral burst”), but it will ultimately wane as the child learns they are not getting the desired outcome by engaging in it.
If you have questions about how to address the challenging behaviors of your child on the autism spectrum, working with an Akron ABA therapist can go a long way toward helping to identify the underlying cause and develop an effective response.
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:
More Blog Entries:
How Our Brecksville ABA Therapists Use Social Stories to Help Kids With Autism, Nov. 3, 2022, Akron ABA Therapy Blog
Cleveland ABA Therapists Explain Our Aim for Generalization of Skills
When our Cleveland ABA therapists structure our behavior therapy sessions, we know that each one may look a bit different depending on the child’s skills and goals. But one thing that’s the same across the board is the main end goal: Fostering the skills necessary for the child to achieve independence. That means that when we’re designing our programs, we aim for the promotion of generalization.
Simply put, generalization is when learning goes from the narrow parameters of a clinic or classroom to much broader ones – essentially being able to apply those skills in real-world settings.
Often when any of us learn a new skill, we do so under a certain set of conditions. These can include things like the person teaching you, the tools you’re using, and the environment where learning takes place. But life is a constant stream of new experiences and situations. To adapt, we need to be able to apply what we’ve learned in unfamiliar situations with new people and different conditions than we’re used to. We may need to learn how to tweak our approach slightly if we want to succeed in certain conditions.
As Cleveland ABA therapists, we want our patients to be able to use what they’re learning in a clinical setting and apply it to real life situations – which more often than not are very different from the circumstances under which they originally learned.
Generalization is when a person can either perform a skill under varying conditions (stimulus generalization), the ability to apply a skill in a different way (response generalization), and continuing to use that skill over time (maintenance).
Many of us take for granted the ability to generalize skills. You learned fractions and decimals in a fourth grade classroom with a single teacher while using your spiral notebooks and No. 2 pencils. But you then learned – probably effortlessly – to apply those skills in the real world, in a setting where you were not with your teacher, in your classroom, with your notebook and No. 2 pencil.
But for people on the autism spectrum, generalization can be tough and may take more practice. Our Cleveland ABA therapists provide opportunities for them to practice. We also introduce variations incrementally, switching up the environments, people, and materials available to the child while we’re working on a skill. We want to help them apply what they’re learning in a clinical setting to the “real world.” Ultimately, this improves their level of independence and flexibility.
Cleveland ABA Therapists’ Techniques for Teaching Generalization
We can start a plan for generalizing a skill almost as soon as we introduce that skill.
For instance, if we know a certain setting was successful in teaching a student one skill, we may implement that same teaching program but in a different setting. So let’s say we’ve been successful in teaching a student to count 1 to 10 in the clinic. We may try continuing to practice that skill they’ve mastered, but in a totally different environment.
Another method would be altering instructions slightly. So let’s say a student does very well in correctly identifying a certain item when we say, “Show me the _.” We would then start switching up the instruction, and instead of “show me the” we would say, “point to the _” or “where is the _?” We might also change the materials we’re using, though we generally start off only altering one variable at a time.
When we know a child has mastered a certain skill, we may start pulling back on our social or tangible reinforcements. For example, we may have given a great deal of positive praise as a reinforcer of expected behaviors and responses before, but then we start to make those less frequent and predictable. In doing so, we increase the chances the child will be able to perform that skill in a real-world setting – where they aren’t likely to receive any praise from others.
Another approach our Cleveland ABA therapists use is to teach the skill in the natural setting where it’s probably going to be used most often. We also follow the student’s motivations and incorporate their interests whenever possible.
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:
Training and generalization of affective behavior displayed by youth with autism. Fall 1996, J. Applied Behavioral Analysis
More Blog Entries:
Top Akron ABA Therapy Strategies, Oct. 27, 2022, Therapy and Wellness Connection Cleveland ABA Therapy Blog
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 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
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
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