Autism and neurodiversity

Autism

What is Autism?

Autism Spectrum Disorder (ASD) or “Autism” is a general term used to describe a set of symptoms with a developmental basis that affect how people communicate and relate to others and experience the world. There is a range of symptoms on the “spectrum” which vary in intensity and presentation from person to person with regards to how much their day-to-day living is impacted.

Back in 1943, Dr. Leo Kanner first described the characteristics of autism and it has since been learned that Autism is a developmental, or lifelong, disorder that affects about 1 in 54 children, with boys being 4 times more likely to be diagnosed than girls (Centers for Disease Control and Prevention). Although there is no known cure for autism, evidence based therapies in use by those practicing ABA have been leading the way in improving lives for those with Autism and their families. 

 What does it look like?

Autism looks different for every individual but there are some common symptoms involved, including:

Difficulty with, or lack of, communication skills

Difficulty with social interactions

Sensitivity  or numbness to sensory input

Reduced or unusual eye contact

Inability to identify emotions in others

Difficulty with transitions

Those who are diagnosed with Autism Spectrum Disorder are unique in their own abilities, talents, interests and potential just like everyone else. As a community, it is our job to ensure these individuals can realize their full potential.

Neurodiversity

The term neurodiversity refers to the fact that all humans, not just those with disorders, develop unique brain structures and response patterns over the course of their lives. You’ve probably noticed that the more you get to know someone, the more unique and distinct they become.

Practitioners in the field of ABA spend a great deal of time in direct treatment, with part of that time dedicated to carefully observing and learning about others in an effort to understand the motivations behind their behaviours. Many practitioners in the field cease to think about those they serve in terms of their diagnosis and think instead about those they serve in terms of their specific behaviours and motivations

The message about neurodiversity that we at Cayman ABA want to spread is that embracing the things that make each of us different and unique is what allows us to support each other effectively and learn to succeed in the world. This is true for our clients, their families, and all of us!

How do I know if my child is making progress?

First it is probably important to define what an ABA practitioner means by progress. In ABA we take data on observable and measurable behaviour, like the number of times someone raises their hand to ask a question, or how long a child takes to respond when their name is called. These data allow ABA practitioners to plan specific interventions to teach, shape, increase, and decrease behaviours. Progress is then defined by those in ABA as a significant change in the data, meaning a change in the behaviour. Let’s look at an example 

The above graph shows an overall reduction in the number of minutes that the child spent screaming. Before ABA intervention, the child screamed for about 6 minutes each day. After day 3 of ABA treatment, (day 8 of measuring screaming), the child was screaming for 4 minutes or less and by day 15 the child wasn’t screaming at all. Looks like progress to me, but one graph doesn’t tell the whole story. If this child wasn’t also taught other behaviours that they can use in the situation that used to cause screaming, the program is not likely to be effective in the long term. So how can you tell an effective ABA program from an ineffective one? 

The Signs of an Effective ABA Program

• A Focus on Teaching, Not Correction

One of the signs of an effective ABA program is the focus on addressing the factors that lead to problem behaviour, rather than a focus purely on the reduction of undesired behaviours. While the reduction of ineffective, inappropriate, or dangerous behaviours is often a goal of treatment plans in ABA, it should only be a component if necessary, with the primary focus of ABA intervention being teaching the client the skills they need to be as successful and independent as possible. If your child is learning and using skills that allow them to be independent and successful, they are likely making progress. 

• The Professionals are Licensed by the BACB (Behaviour Analysis Certification Board)

The process for becoming certified involves classroom instruction, testing, and supervised training in the application of ABA, with several different methods for verifying an individual’s competence. While a certification does not guarantee an effective ABA practitioner, you are far more likely to experience quality ABA services from an individual or team of professionals that are certified. Common certifications in the field include Registered Behaviour Technicians (RBT) and Board Certified Behaviour Analyst (BCBA), but there are also Board Certified Assistant Behaviour Analysts (BCaBA) and those with doctorate level experience and training (BCBA-D).

• A Focus on the Client’s Needs

An effective ABA program is one that focuses on the needs of its clients. This means that everything taught to a client should be meaningful for that client’s life or be necessary for that client to lead a meaningful life. Examples of this include teaching one client to speak by using their iPad and teaching another client to use sign language due to ability or preference. The point of the treatment is to increase the client’s independence and satisfaction by teaching communication. The exact method isn’t what is important; what is important is making meaningful improvements to the client’s daily life.

• The Client Receives Regular Supervision From a BCBA

Have you ever played the “telephone game”? One person whispers something into a person’s ear and then they whisper what they heard. Invariably some things are missed and sometimes the message can be changed altogether, especially when not everyone is motivated to understand the message. When applying the science of behaviour to addressing real concerns, supervision helps prevent treatment from becoming a game of “telephone”. 

Supervision in ABA doesn’t mean that a BCBA shows up and tells an RBT what to do; rather, supervision in ABA allows providers to communicate and collaborate about what they are seeing and how effective different approaches are for an individual client. This process allows for ABA providers to ensure that they are responding to their clients in ways that support progress and improvement in day to day living. 

What is My Role in My Child’s Progress?

One of the reasons that ABA is so effective is because it is so consistent. Taking data allows us to be very precise with how we respond to various behaviours. The more consistently everyone responds to a specific behaviour, the more likely it is for that behaviour to change in response. An effective ABA provider communicates with caregivers regarding how they are responding to your child’s behaviours. Feel free to ask for specific descriptions if needed, or any other questions or clarification. It can often be difficult as humans to tell how well we understand each other and ABA providers should be committed to effective and calm communication that addresses your concerns and answers your questions.

Trusting Your Eyes and Your Gut

If an ABA program is being effective, you will see it and you will feel it in day to day life. It might be small, maybe your child lets you know when they need to use the bathroom without whining, or maybe they ask another kid to play on the playground. It might be big, maybe your child is starting to recognize words and letters or do better at math. If your child seems happy about going to, and coming home, from ABA and you see them succeeding more often in little and big ways, it is likely that the ABA program is effective.  

Behaviour Intervention Plans: What They are and Why They are Useful

What is a Behaviour Intervention Plan?

A Behaviour Intervention Plan (BIP) is an outline that describes, monitors and aims to replace a targeted behaviour. A targeted behaviour is typically one that is harmful or inappropriate, and causes disruption in other aspects of daily life. Targeted behaviours can include non-compliance, tantrums, and self-injurious behaviours. By creating a BIP after an assessment of the client, behaviour analysts are able to determine and describe the target behaviour, and create a treatment plan to decrease the occurrence of said behaviour. Every BIP is specific to the client, meaning we decide what intervention approach to use based on the strengths and needs of each individual. We realize each individual learns differently, which is why we spend quality time ensuring the BIP is the best practice for that client. 

Breaking Down a BIP

Now, when looking at a BIP for the first time, it may seem daunting and confusing. Let’s break it down into the individual components, along with an example to really paint a picture of what exactly a BIP looks like. For example purposes, we will use the random name “Bobby” as our client.

Date: The date the BIP was created.

Ex: 15 April 2018

Behaviour: The target behaviour we are aiming to reduce, and the setting we are working in, i.e. at home, school or in the clinic.

Ex: Tantrum (Clinic)

Operational Definition: Defining the behaviour in a way that can be observed and measured.

Ex: Any episode of crying, flopping to the floor, disrupting objects and/or screaming. Onset is 10 seconds; offset is when he’s calm for 30 seconds. Does not include crying when he is hurt.

Measurement: How we measure the behaviour appropriately; do we measure how often the behaviour occurs, or how long the behaviour occurs for? (These are a few examples, among others, of how we can measure a behaviour).

Ex: Duration

Functional Behaviour Assessment Date: The date the client was assessed to determine the “where”, “when” and “why” of their challenging behaviour.

Ex: 14 April 2018

Function(s): The “why”, or the reason behind, the target/challenging behaviour.

Ex: Attention and Escape 

Function Statement: Specifically describing the function of behaviour.

  Ex: Bobby engages in tantrum behaviour to escape non-preferred tasks, and to gain attention from therapists/peers.

Baseline: Data collected before the intervention starts. 

Ex: January 2018: Baseline data was taken over a period of 10 days and 25 individual sessions in the clinic. Bobby engaged in tantrum 55% of sessions, ranging in duration from 0 seconds to 55 minutes. 

Current Goal: The goal, which is specific, measurable, achievable, realistic and timely, in place for the target behaviour.  

Ex: By August 2018, the behaviour of tantrums will last no longer than 1 minute per episode in the clinic setting, across two different therapists, for a period of 2 weeks. 

Progress: The data collected to determine whether or not the client has made progress with the intervention plan. If this is a new behaviour plan, this section will not be applicable until therapy has started. 

Ex: N/A, as this is a new goal and behaviour plan. 

The next 3 sections of the BIP are the specific intervention strategies used for the client, and are all based on the client’s specific strengths and areas of need. 

Antecedent Manipulations: Preventative strategies must be done before the behaviour happens, not as a reaction to it.

Functionally Equivalent Replacement Behaviour(s): Replacement behaviours are the healthy behaviours we are reinforcing, instead of the challenging/target behaviour we are trying to decrease 

Consequence Manipulations: Reactive strategies are planned responses that all stakeholders must follow, across all environments 

Putting it all Together: Why do we use a BIP?

A BIP is an essential element of ABA therapy. The BIP provides us with all the information needed to implement a behaviour plan and monitor the client’s targeted behaviour(s). As time goes on, we analyze the data taken during therapy sessions, and determine if this behaviour plan is allowing the client to make any progress towards the current goal. If progress is not being made, behaviour analysts will take a step back, and make changes accordingly. A client’s BIP is the foundational resource that is used to ensure the best practices and measures are implemented for their specific needs.