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ACTers of the
Month!
September
Trish
Aubuchon has been a dedicated ACT therapist since
2004. When Trish is not working hard, she spends
time with her three sons, one of whom has Autism.
She also enjoys listening to live
music.
~~~~
October
Terynn
Finkbohner has been a hardworking ACT
therapist since 2004. When Terynn is not
working or studying, she likes to exercise and cook new
dishes for her friends and
family. |
Attention! New
ACT
Social Skills Groups are
Beginning Soon!
~~~~
An
ACT Social Skills group is a great place for your
child to practice their social skills! Fun,
exciting, and creative group activites are led by
experienced ACT therapists and supervisors. Please
contact the front office for more
information.
(805)
529-5265 |
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Dear ACT
readers,
ACT welcomes you to
another issue of the ACT Newsletter. In this
October issue we are presenting an article
that discusses the effectiveness of ABA with
children with Autism and MR, and we are offering
you another tool for your behavior toolbox:
How Can I Decrease Self-stimulatory
Behaviors? We are also going to
introduce you to a very special girl,
Rachel.
ACT has also begun to
pick ACTers of the month. An ACTer of the
month is an employee who regularly goes above and
beyond the call of duty. We at ACT want to
give recognition and thanks to these exceptional
employees for their outstanding work. We
would like to tell our readers about them as
well. Please join us in congratulating
our ACTers of the month for September, Trish
Aubuchon, and October, Terynn
Finkbonher.
We hope you enjoy
this
issue!
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How Can I Decrease
Self-Stimulatory
Behaviors?
 Self-stimulatory behavior
refers to a wide range of behaviors that include
repetitive vocal behaviors (e.g., saying "ticka
ticka" or making truck noises), repetitive motor
movements (e.g., hand flapping or body posturing),
and repetitive manipulation of objects (e.g.,
sprinkling torn pieces of paper or flipping a
puzzle piece over many times). Research has
shown that children may engage in these behaviors
because they provide a pleasurable sensory
experience for the child. These behaviors may also
be a way for the child to self-soothe. It is
common for some children to display these
behaviors primarily in certain situations (e.g.,
when the child is feeling excited, tired, anxious
and/or experiencing other strong
emotions).
Self-stimulatory behaviors often appear to
be some of the most challenging behaviors to
modify; however, with consistency and the right
behavior plan these behaviors can be significantly
decreased. Research has demonstrated that
differentially reinforcing other, or incompatible,
behaviors is a very effective way
to reduce the frequency of self-stimulatory
behaviors. There are a few ways to implement
a differential reinforcement procedure.
In a differential reinforcement of
incompatible behaviors (DRI) procedure, the child
is reinforced for engaging in a replacement
behavior that is incompatible with the
self-stimulatory behavior (i.e., the child can't
engage in both behaviors at the same time).
This works well for decreasing repetitive motor
movements or vocal behaviors that occur in
specific and somewhat predictable situations
(e.g., a boy who flaps when he is excited or a
girl who mumbles incoherent words when she is
upset). In these situations, you can
reasonably foresee when your child will engage in
the self-stimulatory behavior. Also, you can
identify the likely function of the
behavior. In the above examples, the boy who
flaps is expressing his excitement and the girl
who mumbles may be expressing her emotions or
trying to self soothe.
When designing a DRI procedure it is
important that the most appropriate replacement
behavior is taught. A replacement behavior
should be incompatible with the self-stimulatory
behavior and should serve a similar function for
the child. For example, for a boy that
usually flaps his hands when he is excited, a good
replacement behavior is clapping his hands.
Clapping is a good choice because it is
incompatible with flapping and a socially
acceptable expression of excitement.
For the girl who mumbles to express her emotions
or self soothe, it might be effective
to teach her to say a specific phrase that
communicates that she is upset and/or engage in
deep breathing. Both are incompatible with
mumbling and serve similar functions to the
mumbling.
Once you have identified the function of
the self-stimulatory behavior and you have chosen
an appropriate replacement behavior, you can begin
your DRI procedure. It is important to
catch your child before he engages in the
self-stimulatory behavior and prompt him to engage
in the replacement behavior. If you
consistently let your child engage in the
self-stimulatory behavior and then prompt him to
engage in the replacement behavior, he may learn
to pair the two behaviors instead of replacing one
behavior with the other. When your child
engages in the self-stimulatory behavior or you
think he might engage in it, prompt him to engage
in the replacement behavior instead and then give
him a reinforcer. Self-stimulatory behaviors
are inherently motivating for the child so it is
important that the reinforcer be strong and more
motivating than the behavior itself. This
may be the time to bring out the most powerful
reinforcers you have.
For children who engage in self-stimulatory
behaviors in many different settings and
situations, or continuously throughout the day, it
may be more useful to set up a differential
reinforcement of other behaviors (DRO) plan that
reinforces every other behavior except the
self-stimulatory behavior. In other words,
reinforce the absence of the
self-stimulatory behavior and the presence of any
other appropriate behavior. In the DRO
procedure you are going to periodically reinforce
your child for not engaging in the
self-stimulatory behavior; you shouldn't specify a
replacement behavior.
Begin by figuring out the shortest amount
of time your child can go without engaging in the
behavior. For some children this may be 10
seconds and for other children this may be 10
minutes or more. Taking data on the behavior
will help you get an accurate number. You
want to start with the smallest amount of time so
your child can be very successful and earn his
reinforcer. Use a digital timer to time
intervals. For children who are able to
understand, you can explain in a simple way how
this works and let them know what they will be
earning. For other children it may be more
appropriate to have a simple two word phrase to
use (e.g., "No noises" for a child who makes loud
noises). Give this instruction when the
timer starts. If the timer beeps and your
child has not engaged in the behavior, give him a
powerful reinforcer. If he does engage in
the behavior during the interval, you should
repeat the phrase and start the timer over
again. Reduce the required time if your
child is not meeting with at least some
success. Once your child has gotten used to
this routine, you can gradually begin to increase
the intervals of time during which he cannot
engage in the target behavior.
You can modify this DRO procedure by having
your child engage in activities that are
incompatible with the self-stimulatory
behavior. For example, if you are trying to
decrease a vocal behavior, you can have the child
remain completely silent or read aloud. Once
you begin to have significantly longer intervals,
however, it would not be recommended to have your
child be silent for the duration. You can
certainly engage in puzzles, homework, games and
other activities during these intervals.
In conclusion, DRI and DRO procedures can
be very effective for reducing self-stimulatory
behaviors. Remember, consistency and
patience are very important when trying to
implement these procedures. If you can stick
with it and be consistent you can successfully
decrease your child's self-stimulatory
behaviors.
Good
Luck!
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The Effectiveness of ABA with
children with Autism and
MR
 In our last issue,
we discussed the issue of ABA's effectiveness with
older children with Autism. There have been
similar questions about ABA's effectiveness with
children with Autism and mental retardation
(MR). MR is measured by IQ and is
categorized into ranges of mild, moderate, severe
and profound impairment. Approximately 70%
of children with Autism also have a diagnosis of
MR, although this statistic has been the source of
some debate. There are studies which have
examined the effectiveness of ABA specifically
with children with Autism and MR. A few are
reviewed below.
One such study was
conducted by Smith, Eikeseth, Klevstrand and
Lovaas in 1997. This study examined 21
preschoolers with Autism and MR. The average
IQ of the students before treatment was 35 (i.e.,
severe MR). Students randomly assigned to
the treatment group received 30 hours of ABA per
week, and children assigned to the non-treatment
group received "minimal" treatment. After 35
months the students in the treatment group
obtained significantly higher average IQ scores
and demonstrated more expressive speech than the
non-treatment group. The study also reported
a decrease in problem behaviors for both groups of
students. In a similar study, Eldevik,
Eikeseth, Jahr and Smith (2006) gave children with
Autism and MR 22 hours of ABA per week for 2
years. The average IQ of students before
treatment was 41. The treatment group showed
significantly more change than the
control
group in intellectual functioning, receptive
language and expressive language. Both of
these studies reported smaller increases in IQ and
language than what has been observed in higher
functioning people; however, both demonstrated
that people with Autism and MR make steady
improvements over time in response to ABA-based
therapies.
It is also important to
note that because MR is considered so prevalent in
people with Autism, most studies do not exclude
people with MR, as it would significantly decrease
the number of subjects they could use. In
fact, most of the research that examines Autism
treatments includes children with Autism and
MR. Therefore, the majority of results,
unless explicitly precluded, can be extrapolated
to a limited degree to people with Autism and
MR.
Lovaas' initial study of Discrete
Trial Training for children with Autism included
children with MR. In this study (1987) the
children in the experimental group showed
increases in IQ scores of an average of 30 points
overall after treatment. Interestingly,
there were 10 children with moderate to severe MR
included in the experimental group. After
treatment, only 3 of the 10 children remained in
the moderate to severe range of MR. In other
words, 70% of the children with Autism and MR
moved out of the moderate to severe MR
ranges.
Howard, Sparkman, Cohen, Green
and Stanislaw (2005) included children with MR in
their study and found that the children who
received intense behavioral treatment (IBT) showed
significant progress in cognitive, language,
social, and self-help skills. Sallows and
Gaupner (2005) included students who had IQ's
ranging from 35 to 75 (i.e., mild to moderate
MR). After 4 years of treatment 11 of the 23
children had IQ scores in the normal range (i.e.,
above 85). The authors identified two
classes of learners: rapid and moderate learners,
who showed smaller increases in IQ than the rapid
learners did after 4 years of treatment.
About moderate learners the authors stated:
"Although these children did not 'catch up' to
peers, they did show increases in developmental
age equivalents. At the end of the study
these children were continuing to gain skills at
the rate of 3.4 to 4.3 months per year (in
language and social skills)."
The
list of studies which demonstrate that ABA
significantly helps children with Autism and MR is
lengthy. After having reviewed just a few of
them here, it is apparent that there can be no
question about whether ABA is an effective
treatment for children with Autism and certain
levels of MR. The diagnosis of MR may affect
other treatment variables, such as length of
treatments, intensity, and treatment goals and
appears to impact the rate of
acquisition. |
Rachel's
Story
ACT would like to introduce our readers to
a remarkable young girl named Rachel! Rachel
is a bright, active, and easy going eight year old
who loves to ride her bike and spend time with her
family.
When Rachel was just 18 months old her
parents, Connie and Robert, brought her to
ACT. Connie recalls that during this time
Rachel didn't respond to her name and didn't
interact with the family. Rachel couldn't
use functional speech to express her needs.
If someone said "no" to Rachel, she would tantrum
to show her frustration. She needed constant
supervision during free time because she would put
objects in her mouth and run away. Her older
sister, Alex, tried to engage Rachel in play, but
it was difficult. Going out as a family was
also a challenge because of the preparation it
required in anticipation of Rachel's needs.
When Rachel began therapy with ACT, her
treatment focused on decreasing her tantrums and
mouthing of objects and teaching her functional
communication, cognitive, and play
skills. To address communication skills, ACT
began to teach Rachel how to use the Picture
Exchange Communication System (PECS). Rachel
responded to PECS very quickly and began to make
simple requests by giving a picture to an
adult. Rachel learned to use some sign
language as well. Therapy also focused on
teaching Rachel basic play skills (e.g., taking
turns). There were periods during Rachel's
treatment when her rate of learning appeared to
slow down; however, these periods would eventually
pass and Rachel's rate of learning would return to
its usual level. She was receiving
approximately 40 hours of therapy per week during
this period of her treatment.
ACT therapists currently work with
Rachel at school as her aides. They
help Rachel communicate with others, interact more
with her peers, and learn new academic material in
an effective manner.
In May, 2008 Rachel began to use a voice
output device (VOD) or augmentative communication
device. She uses it at school, at home, in
the community, and during therapy. Connie
says that Rachel uses the VOD spontaneously now
and that she is continuing to improve her
skills.
Connie reports that Rachel has made very
significant gains across the past six and a half
years. Currently, Rachel has almost no
behavior problems. She is able to
effectively communicate her needs, play
cooperatively with peers and Alex, her sister,
sometimes independently and sometimes with
support, and she regularly helps the family by
setting the table and emptying the
dishwasher. She is part of a soccer team and
a "lunch bunch" where she eats lunch
with regular education peers at
school. Rachel can sight read and is
learning to type and use a calculator.
Connie says that life is more relaxed now.
She can, for example, cook dinner and not worry
about what Rachel is doing in the house.
Family outings are also more relaxed and
productive.
Connie specifically requested that Dr.
Anderson, Dr. Barbi and all of the ACT therapists
who have worked with Rachel be thanked for their
hard work and dedication. "ACT is awesome!" she
exclaims. Lastly, Connie wanted to impart
the message to families of never giving up, no
matter what
happens.
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We hope that you have enjoyed this issue of
ACT's Newsletter and found it useful! Please
contact us if there are topics you would like to
see addressed in the newsletter in the
future. You may suggest topics by sending an
email to: Sarah.Pashalides@AutismCenterforTreatment.com
Look for our next issue in
December,
2008!
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