ABA Must Not Overlook Adolescents and Adults

By Shaji Haq, Ph.D., BCBA-D

 

Over the past twenty years, applied behavior analysis (ABA) treatment providers for children with developmental disabilities—particularly autism spectrum disorder (ASD)—have multiplied exponentially.  But ABA treatment facilities for adults are sparse.  This is a tragedy; we’re often stopping short when treatment is still critical, and in some cases, even more so.

Many factors may have contributed to the increase in children’s ABA providers (e.g., Lovaas’ seminal study on the effectiveness of early intensive behavioral intervention in 1987, mandated insurance coverage, and funding and research for ASD treatment), but this increase addresses only part of the issue.  Students with ASD often “age-out” of school systems or ABA agencies, leaving families with limited options—limited in terms of effective treatment, and limited in helping loved ones access services which are critical to independent, adult functioning.

Adult clients may lack the skill to participate in vocational or community integration programs.  For example, adults with ASD who cannot successfully participate in community programs might have severely limited communication skills, difficulty managing personal hygiene, or display severe behavioral inflexibility (e.g., insistence on sameness of routines) that can be barriers to those programs.  Many of these individuals also display problem behavior, such as aggression and self-injury, which often excludes them from participation.

Without ABA services to improve skills and treat behavior problems, the situation may seem bleak.  But it doesn’t have to be.  The key to ABA treatment is always identifying the cause of behavior.  Experimental functional analyses (Iwata et al., 1982/1994), also commonly referred to as Functional Analysis Assessments (FAAs), are the gold standard for identifying the function, or purpose, of problem behavior for individuals (regardless of age) with developmental disabilities.

FAAs are an area of service CBS has begun to provide, which is not commonly found in Southern California.  Our FAAs use rigorous data collection systems and research-based experimental design.  Since 2004, Center for Behavioral Sciences has emphasized teaching individuals of all ages with developmental disabilities to reach greater levels of independence, and our new FAA program is a great step forward.

While an FAA and any behavior intervention translates to vastly different outcomes across individuals, at Center for Behavioral Sciences, we believe that older clients must be recognized as an equally-important population to children with ASD.  Adult treatment goals may range from basic activities of daily living to more advanced skills, such as time management, decision making, how to use public transportation, and vocational training.

If you are interested in finding out about our FAA program, our Intensive Treatment Center or our other services, you can follow the menu above or contact us to learn more!

 

References

Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197-209. doi: 10.1901/jaba.1994.27-197 (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3-20, 1982).

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young children with autism. Journal of Consultation and Clinical Psychology, 55, 3-9. doi: 10.1037/0022-006X.55.1.

 


Disclaimer: This article is for general information only, and is not intended as legal or medical advice.  Individual circumstances and outcomes vary, and the statements in this article may not apply to you. Please contact your health care provider or attorney regarding any specific issue or problem.  The opinions expressed in this post are the opinions of the individual author and may not reflect the opinions of CBS.

©2018 by Center for Behavioral Sciences, Inc.  All rights reserved.

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Broccoli in brown bowl

A Behavior Analyst’s Tips for Picky Eaters

By Dr. Joyce Tu, Ed.D., BCBA-D

Overview

Caring for a loved one with developmental disabilities can pose unique challenges, which are not always adequately addressed by conventional methods. We have covered how to tackle toilet troubles and chronic sleeping issues. Below, Dr. Joyce Tu, Ed.D, BCBA-D, shares one program to help parents and caretakers introduce new foods to picky eaters.  From a behavior analyst’s perspective, eating may be addressed using the following framework:

  • The Premack principle (the principle that more likely behaviors, can be used to reinforce less likely behaviors);
  • Shaping (reinforcement of behavior resembling a target behavior);
  • Fading (gradually reducing prompts or reinforcers); and
  • Positive reinforcement (presenting a reinforcer to make behavior more likely).

If this seems too technical, don’t be discouraged; the program itself is fairly simple!  Your child (or other “picky eater”) will be introduced to various types/shapes/sizes of food throughout the day by using these principles, and can gradually expand her daily menu.

Program

First, you’ll need to identify a reinforcer—a favorite food that your “picky eater” already likes.  Then, choose a new food which you would like to introduce to her diet.  Next, for each bite of new food that your “picky eater” eats, immediately give her a bite of her favorite food.  This is “positive reinforcement.”  (See, it isn’t so hard!)

Alternatively, you can start more slowly and present a bite of her favorite food when she first touches the new food.  Then, when your “picky eater” gradually brings the new food closer and closer to her mouth, give her a bite of her favorite food.  This is called “shaping.”

Gradually increase the ratio of new food to a favorite food, to 2:1.  In other words, when your “picky eater” eats two bites of new food, present one piece of her favorite food.  Later, increase the ratio to  3:1, then 4:1. By changing the ratio this way, you are using a “fading” procedure.  When the ratio of new food vs. favorite food has increased to 5:1, you can then introduce a second new food.

When introducing the second new food, have your “picky eater” take a bite of the second new food, then a bite of first new food, then five bites of her favorite food. The ratio of the second new food, to the first new food, to a favorite food should be gradually increased to 2:5:1 (i.e. two bites of the second new food, five bites of the first new food, and one bite of a favorite food).

Gradually increase this ratio of the second new food vs. the first new food, vs a favorite food, to 3:5:1, 4:5:1, etc.—until your “picky eater” begins eating both new foods without your help. Using the same procedure, you can then introduce other new foods.

 


Disclaimer: The recommendations provided are general. For specific recommendations for you and/or your child please consult with a behavior analyst.
 
©2017 by Center for Behavioral Sciences, Inc.  All rights reserved.

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Closeup of Mother and daughter spending time together

Toilet Training Made Easy

Introduction

 

Caring for a child, potty accidents come with the territory, especially for those with developmental disabilities such as autism. As common these issues are, the good news is that they are also highly manageable. Our step-by-step guide below aims to tackle even the trickiest of toilet troubles. Let’s dive right in!

The goals here are two-fold.  First, we’ll aim for seven days in a row with no more than one accident.  The long-term goal is for your child to use the toilet for every elimination with no assistance.  This program requires that your child be able to walk, sit for approximately 2-3 minutes, and grasp with her hands.  You will also need the following:

  • Training pants (preferably regular underwear).
  • Simple clothing: no pants/elastic waistband pants, or short shirts for girls.
  • A child-size toilet seat, or child’s potty chair if your child is uncomfortable on the adult toilet. (If you use a potty chair, keep it in the bathroom at all times.)
  • A variety of your child’s favorite drinks.
  • A variety of small food treats that your child likes. (Note: be sure to only make these food treats available as a reward for dry pants! Do not use these treats for anything else.)
  • A variety of your child’s favorite toys and activities.
  • Two or three days of free time with minimal disruption for training.

Understanding the Two Basic Procedures

 

Procedure 1: Toileting

Using the toilet is a chain of many small steps. Your child must be taught each of the following steps to help her learn these habits effectively:

a.  Come up with a signal for your child to use to tell you she needs to go to the toilet:

Ask, “where do you go potty?” and vocally prompt the answer “toilet” or “bathroom.” Have your child imitate “toilet” or “bathroom” aloud if necessary. Praise your child for answering “toilet” or “bathroom.” If your child cannot talk, have her use a gesture or a picture.

b.  Have your child walk to the bathroom in front of you. Physically prompt your child to do so if necessary.

c.  Have your child take down her pants and sit on the toilet.

d.  Give your child 2-3 minutes to use the bathroom. Encourage her to do so by stating “go potty.”

If your child eliminates, praise her and provide food treats (or other reinforcers of their choice). If your child does not eliminate, ignore it. Do not scold or express disappointment. Go to the next step.

e.  Flush the toilet (or empty the portable potty) only if your child eliminates.

f.  Say “Get down” and have your child pull up her pants.

g.  If this was performed during a wet version of the “dry pants check” (Procedure 2 below), have your child walk back to the place she wet herself and change to dry pants

h.  Continue with the toileting schedule.

Procedure 2: Dry Pants Check

This is a way to teach your child that you want her pants to be dry all the time.  The procedure is as follows:

a.  Ask your child “Are you dry?” Help your child place her hand on the crotch area of her pants so that she can feel for wetness.

b.  If your child is dry:

Praise her for being dry (e.g., “Nice dry pants”), and give her lots of social reinforcers (e.g., hugs, kisses). Then give your child a small piece of the food treat or a sip of a drink.

c.  If your child is wet:

Tell her “No wet pants.” Take her immediately to the toilet (using Procedure 1 above). Have your child do as many of the steps as possible and use hand-over-hand prompting for those steps your child does not know.

d.  For the steps your child can partially perform:

*Pair every step in this procedure with the actual instruction (e.g., “walk to the bathroom”).

*Do not talk to or praise your child during this procedure; only give those verbal instructions to complete the step(s) involved. Your voice should be calm but firm.

*Do not scold or reinforce behavior (such as with a drink or affection) during this procedure.

Day One

 

Step 1. Change & Drink:

After a small breakfast (no starches) change your child’s diaper to training pants. At breakfast have your child drink at least 1 ½ cups (6 oz.) of her favorite drink.

Step 2. Perform Procedures 1 & 2:

Five minutes after breakfast perform a dry pants check (Procedure 2).

If your child is dry, praise her and give her a small piece of her food treat. Then ask, “What do you need to do?” Verbally prompt your child to state, “Go potty.” Proceed to performing toileting (Procedure 1). If your child eliminates, give her lots of praise and a reinforcer of her choice. If your child does not eliminate, say “nice try” and continue with the toileting schedule below.

Step 3. Toileting Schedule One:

After performing the above procedures, repeat the following cycles:

a.  Every 10 minutes: Dry pants check (Procedure 2).

b.  Every 20 minutes: Toileting (Procedure 1). Do this approximately 10 minutes before your child has a bowel movement (BM).  The BM schedule is based on what you recorded on the original toileting data sheet prior to training. Record whether your child was dry, wet, and/or had a BM.

c.  Every 1 hour:  Have your child drink a ½ to 1 cup of her favorite drink.

Step 4. Toileting Schedule Two:

When your child is eliminating in the toilet with no accidents for at least three hours:

a.  Every 15 minutes: Dry pants check (Procedure 2).

b.  Every 30 minutes: Toileting (Procedure 1).

c.  Every 90 minutes: Have your child drink a glass of liquid.

If your child has four or more accidents in a row, have your child repeat the toileting procedure after each accident two times and decrease consumption of the drink to a ½ cup.

Final Steps:

For every three-hour interval your child goes without any accidents:

  • Increase the intervals between dry pants checks and toileting procedures by 5 to 10 minutes.
  • Increase the intervals between liquid consumption by 30 minutes.

Diapers should only be worn when your child is asleep.  Eating schedules should be kept the same, but prepare lighter meals with fewer starches.

Day Two and Beyond

 

Continue with the same toileting schedule you ended with on Day 1. When your child is eliminating every two to three hours, stop giving liquids on a scheduled basis and slowly thin out (decrease) reinforcers for eliminating in the toilet.  By continuing to follow this procedure, you and your child will be on the way to success!

 


Adapted from Toilet Training in Less Than a Day by Nathan H. Azrin and Richard M. Foxx

Disclaimer: The recommendations provided are general. For specific recommendations for you and/or your child please consult with a behavior analyst.

©2017 by Center for Behavioral Sciences, Inc.  All rights reserved.

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