Transitions: How to Decrease Anxiety and Increase Compliance

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In our daily lives we transition constantly from places and activities. Thanks to schedules and daily routines, we have a map of what our day generally entails. Now imagine you are asked to start a project, but all information regarding expectations and deadlines is being withheld until after the project has already begun. That scenario would almost certainly leave you feeling frustrated and anxious. Knowing what is expected and when it is needed gives us a sense of accountability, responsibility and contentment.

Those feelings of frustration and anxiety when expectations and schedules are unclear may last longer and be more intense for individuals with an Autism Spectrum Disorder (ASD). They may exhibit their frustration in the form of tantrum-like behaviors, which may include screaming, hitting, biting, scratching, throwing themselves on the floor and/or other self-injurious behaviors.

Managing this type of anxiety involves two key components. While we want children to follow routines and schedules, we also want them to be flexible enough to handle situations that are unscheduled and to cope with unanticipated events. To effectively manage anxiety, we focus on utilizing schedules to increase compliance and how to handle unexpected events that arise.

A schedule is usually used so the child can refer to it and have a visual reminder of what is occurring throughout their day. We can use different types of schedules:

  • Picture schedules allow the child to visually see the type of activity coming up (i.e. numbers for math, a swing for the park, etc.)

  • A child who can read may benefit from smaller to no pictures and many to all words on their schedule. We also like to fade pictures as the child makes more associations with the activity using words rather than pictures.

There are many other types of schedules that can be used depending on the child’s age, needs and preferences.

Along with schedules, we utilize timers and verbal cues as additional signals that the current activity is close to ending and that a transition is coming. Typically, when we give reminders of what is expected or what is coming up, we see a smoother and quicker transition than when those cues are not presented. Something as simple as “2 minutes left until lunch time” can make all the difference.

This brings us to the unexpected situations. Sometimes a store is closed, there is no glue left for arts and crafts, or bad weather interrupts an outdoor play date. Unforeseen circumstances like these can lead to tantrum-like or self-injurious behaviors. For these situations, we suggest using breathing and calming techniques as well as social stories to help bring awareness to the situation.  These techniques are not taught during an “episode” but should be introduced preemptively during more relaxed moments. Explaining that certain items aren’t available or that something can’t happen is easier and often better received outside of the situation since the child is not in a heightened state of anxiety or frustration. These strategies can also help in situations where you can anticipate a difficult situation like loud noises or crowds.

These are just some of the many ways to alleviate anxiety and frustration when dealing with transitions and unexpected changes. The Behavior Technicians and BCBAs that work with your child can make schedules and social stories tailored to your child’s specific needs to promote independence.                 

Stephanie Riccardi, M.S., BCBA, LBA
Associate Clinical Director, New York
October 8, 2019

From Miss to Mrs., With Our Best Wishes!

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In late September, Behavior Frontiers HQ came together to celebrate the upcoming nuptials of our Marketing and Events Coordinator, Dannielle Lon. Dannielle, who also just celebrated her one-year Work-a-versary, was showered with gifts, enjoyed some fun games, and had some fantastic food, all courtesy of the wonderful BFHQ team.

“Thank you to my amazing coworkers who put together my SURPRISE Bridal Shower completely under my radar. Apparently, it was planned for weeks and I literally had no idea. …Celebrating with everyone was one of the most perfect ways to count down to the next chapter in my life!”

Congratulations to you, Dannielle, and from all of us at Behavior Frontiers, may your marriage be filled with lots of laughs, love, and happiness!

Tuesday, October 1, 2019

Improving Behaviors in Everyday Life

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If you are reading this blog, you likely interact with a child with autism or other special needs on a daily basis. Whether you are the child’s parent, teacher, therapist, or classroom aide, you have probably faced some challenging situations in which you wished you had more tools to help the child.

An understanding of some key concepts can be helpful to you and your child in your home, school, and community environments. Motivating the child to increase opportunities for communication is one of the most widely targeted skill areas in ABA.

Outside of your child’s sessions, parents and caregivers are the real champions! Involved parents implementing the concepts outside of therapy helps to promote consistency and generalization across people and environments. If you think about it, parental involvement is one of the most important aspects of therapy.

Think about learning a foreign language. If you’re only studying for five hours per week, it could take a very long time to master the language, or risk not being very successful. The exact same idea applies to ABA therapy. It is imperative that outside of therapy, parents are utilizing the same methods that are used during treatment. Whether that is implementing the child’s behavior plan, running programs for the child’s goals, or working on your communication system. The extra time parents and caregivers take to work on programming can make a huge difference in the child’s success.

In order to apply behavior change methods, the first thing you need to understand is how the child’s behavior relates to their environment. The surrounding situations, or environment, when the child’s behavior happens is often referred to as the ABC’s of Behavior. This stands for Antecedent, Behavior, and Consequence. Very simply, the antecedent is the situation before the behavior, and the consequence is the situation after the behavior in question. It is important to be in control of both antecedents and consequences to increase or decrease the child’s behavior for the better. Reinforcement is one possible consequence of behavior.

It is important that you are aware of and control the consequences that you give the child. Every behavior a child engages in, whether considered “good” or “bad,” will either increase or decrease based upon the consequences s/he receives. You are always teaching through the consequences that you provide and our goal is for you to be able to use the ABA methods presented to change your child’s behavior for the better.

Now let’s discuss the behavior principle of reinforcement. Reinforcement is a powerful tool to increase the child’s appropriate behavior. Reinforcement occurs when the consequences that immediately follow a behavior increases the future occurrence of that type of behavior in similar situations.

Reinforcement can also be described as either unconditioned or conditioned.

•       Unconditioned reinforcers are when the child receives basic needs such as food, water, or warmth, which lead to the behavior increasing in the future.

•       Conditioned Reinforcers -- also called secondary or learned reinforcers -- increase behavior because of their previous pairing with reinforcers. Examples of positive, conditioned reinforcers are when the child receives social attention, toys, stickers, or tokens, which lead to the behavior increasing in the future.

Our innate need for reinforcement can be explained with this example: You’re at work. You’ve been working for the last two weeks on a really difficult project that none of your coworkers volunteered to do. The project gets turned into your boss, and not one person thanks you or says “good job”. That stinks right? Are you going to volunteer to do that project again? Probably not. The same thing goes for the children in our lives. If you’re working on a skill with your child, and they engage in that really difficult target behavior, it is imperative they receive a reward that is meaningful to them, be it praise or an item they really like. Without that addition of reinforcement, the likelihood that the child will engage in that behavior in the future becomes slim.

Now that you have learned about the types of reinforcement and its importance, we are going to go over guidelines for you to follow when using reinforcement with your child.

The first reinforcement guideline is to give reinforcers immediately following the correct response thereby ensuring that the child receives the reinforcement for the correct behavior and not for another behavior we are not attempting to reinforce. In order to give reinforcers immediately, you must prepare reinforcers beforehand, such as by gathering reinforcers and placing them in an easily accessible place prior to teaching your child.

The second reinforcement guideline, which we can’t emphasize enough, is to be energetic and exaggerate your positive reinforcement. The child should be able to notice a big difference in your reaction to his or her correct responses.

The third reinforcement guideline is to always pair social reinforcers, such as attention and detailed praise, with other reinforcers. Since children with autism have social deficits we must often pair a primary reinforcer with a secondary reinforcer so they can learn to enjoy things such as praise or social attention. For example we sometimes pair the conditioned reinforcers of praise and high fives with the unconditioned reinforcer of a food treat. This is done so that praise can have the same reinforcing qualities of a food treat, and we can work on fading away the food treats over time. It is also a good idea to pair yourself with reinforcers, by pairing your arrival with the delivery of reinforcers, such as toys, tickles, and treats.

Finally, it is important that you use highly preferred reinforcers for difficult or long tasks. For example, if the child really loves to play on the computer then you can use the computer so that the child can earn his favorite activity if he completes a difficult writing activity.

Jaclyn Colvin, M.Ed., BCBA
Associate Clinical Director, Novi, MI
September 24, 2019

Celebrating and Motivating our Staff -- It's How We Roll

Our San Gabriel Valley team went out and about to celebrate Senior Behavior Therapist Tanya Vargas’ baby shower! The group met at Mimi’s to partake in some good food and fun, and to wish Tanya well.

This is just one of many employee socials that San Gabriel Valley has had over the past few months. Other highlights have included a street food festival with a movie under the stars, a Dodger game, an escape room adventure, and a group scavenger hunt! Clinical Director Joy Wong isn’t done celebrating her employees just yet – September’s employee social will be a wonderful evening of bowling and bonding with the entire team.

At Behavior Frontiers, we love to celebrate and motivate our employees. That’s why every single region hosts multiple employee appreciation events throughout the year. It’s just one of the many ways we express our appreciation for all of the amazing work that our wonderful staff does every day!

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September 17, 2019

Treating Obsessive and Ritualistic Behaviors

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In a previous blog post (Understanding Obsessive and Ritualistic Behaviors, August 6, 2019) we discussed why rituals and obsessive behaviors are detrimental to both the child’s life and the life and well-being of his/her family. We discussed how important it is that behavior technicians (BTs) play a role in recognizing, defining and communicating the child’s rituals and obsessive behaviors with the team. Next, we will discuss the kinds of treatment that work best for children with these challenging behaviors.

Managing rituals and obsessive behavior is particularly difficult because when children are blocked from engaging in these behaviors, they often engage in equally challenging behaviors such as aggression, tantrums, yelling, crying, or “shutting down.” The goal is to reduce these challenging behaviors, as well as the rituals and obsessive behaviors.

The first step is to ensure that the child has the proper replacement behaviors. If a child does not have the proper replacement behaviors in place, then those must be taught first. The BCBA will determine if the needed replacement behaviors are in place; however, BTs can aid in communicating to the BCBA if replacement behaviors are seen during sessions. Common replacement behaviors for the reaction to being blocked include emotional coping strategies. For example, you could ask yourself the following questions:  Is your child able to take deep breaths rather than cry and scream? Does your child recognize when s/he may need to walk away from a situation to avoid having a meltdown?

Although we may not be able to change the child’s mind regarding why the ritual is absolutely necessary, we can teach him/her to react to changes as they occur. For example, you could teach replacement behaviors, such as taking deep breaths, counting backwards from 10, taking some time alone, or getting some water. BTs can assist in testing the various strategies and seeing which works best for the specific child --We all have different ways of calming ourselves down. Since BTs spend a lot of time with the children, the BCBAs will likely rely on observations and data from them regarding which coping strategies work the best for each child. The bottom line is that having coping skills helps children be more flexible with changes in their rituals or when they are blocked from performing their obsessive behavior.

Another important skill is called “Social Perspective Taking.” Let me paint a picture for you: I have an obsession with coasters. I really love to have a coaster under any drink whether it is at my home, my office, or someone else’s home. I have many coasters in my home to make this happen; however, other people often put their drinks down on my wood table. Social perspective taking allows me to know what another person might think or feel if I get overly upset about them not using a coaster. If I yell at them, they might feel mad. They might think: What is her problem? It’s not that big of a deal. I am able to identify this because I have the skill of Social Perspective Taking. When children are not flexible with changes in their environment, then BTs can point out how others might feel. Many children may not yet have this skill, so prompting them through a situation can help them learn to understand others’ emotions and thoughts.

Additionally, it may be difficult to find a strong enough reinforcer for the replacement behavior to successfully change the obsessive behavior. Oftentimes, the most preferred reinforcer for rituals is engaging in the ritual itself. You may consider reinforcing the child’s use of replacement behaviors with the chance for the child to engage in one ritual behavior. This often works well with children who have multiple obsessions but it can also be used for children who have only one obsession. For example, if your child really only likes talking about cars, you could reinforce engaging in novel topics of conversation with the opportunity to talk about cars.

Ritualistic and obsessive behaviors can be difficult to treat. Working together to create an individualized treatment plan can assist in increasing flexibility and overall use of replacement behaviors. You may not be able to change the child’s mind regarding the importance of the ritual; but you can teach the child replacement behaviors to help him/her be more flexible. Flexibility typically leads to better social relationships and greater independence in children’s lives. It can also be hugely helpful in the life of the entire family. Make sure to notify your BCBA if you see any signs of ritualistic and obsessive behaviors so they can be properly addressed during your child’s ABA sessions.

Allyson Kroneberger, M.S., BCBA, LABA
Associate Clinical Director, Boston, MA
September 10, 2019