We are what we learn to do..

I was browsing on the internet and I found this picture about "tantrums" and "autism meltdown." This picture describes two separate behaviors that parents often observe among their children diagnosed with autism. These behaviors are also often observed in children of typical development.

This picture paints an inaccurate image of how behavior should be observed and does not provide an accurate reflection of how most behaviors function. Behaviors be it a tantrum behavior or an "autism meltdown" is a function of the environment. Because each child with autism is affected differently by autism, each behavior is unique. We as human beings also respond differently to the same set of environmental conditions.

Therefore, to say that a tantrum is "Want directed" for example is a generalization. It can be "want directed", but we don't know this until a formal functional assessment is done. Some children with autism, tantrum due to routine changes, unexpected events, sickness, etc. We will never know why a behavior happens until a formal assessment is done. Therefore tantrum behavior and the antecedent for that behavior will depend on the child and the child's current environment.

In addition, I don't quite comprehend what is an "autism meltdown". All behaviors in our environment especially when dealing with a child with autism, should be objective and well defined. In other words, how do we know if a child is "overstressed or overwhelmed?" How do we measure this subjective behavior? But, we as behavior analysts can measure screaming, crying, shouting, etc and based on those observable behaviors that can me measured, will determine why the child is doing what he/she is doing.

"As each of us experience varying contingencies of reinforcement, some behaviors are strengthened and some are weakened.....We are what we do and we do what we have learned to do." ( Cooper, Heron & Heward, 2007)

We do what we have learned to do. Children with autism have learned to do what they do through contingencies set by their environment. Behaviors have four functions:

1) Attention maintained
2) Escape maintained
3) Automatically maintained
4) Play maintained

A functional behavior analysis should be done to determine the function of a behavior. In other words, if you child is engaging in "tantrum behavior" or an "autism meltdown," a good behavior analyst should determine the function of these behaviors through (a) a functional analysis, (b) descriptive assessments and (c) indirect assessments. Please ask your provider about these assessments when looking at behaviors of concern such as the above. The less assumptions we make about behavior the more effective teachers we will be to our children.

For more information on these assessments, please feel free to email littlestepsmalaysia@gmail.com

psst...excuse me..

I have a 5 year old little sister and she is a ball of energy. She's very enthusiastic, loves talking, constantly asking questions, loves soccer and she thrives on social attention. She's constantly urging us to look at things that are interesting to her and asking us questions about it. She's constantly engaging us and seeking to share her excitement. I am always so amazed with her.

My amazement lies in how hard we work to teach these skills to children with autism. Yet, my five year old sister has learned social contingencies just through observation. It is truly incredible. Once again, like everything else, I start breaking it down in my head. In learning social contingencies there's so many pre-requisite skills a child must have for example, eye-contact, generalized imitation skills, pointing, labelling, responding to initiations, following rules, giving/receiving directions and most importantly, learning the value of social contingencies.

To illustrate my point better, here's another story about my sister.  Yesterday, at the grocery store,  she saw a man in a wheelchair. She stared at him briefly and then pulled me aside to make sure the gentleman in the wheelchair was not looking at her. She pulled my arm down so she could get closer to my ear and whispered, "why is that man in the chair?". How does a typical 5 year old know that if she says that loud, she might offend him or hurt his feelings? Where has she learned to whisper? or to pull my arm down discretely to get my attention making sure the gentleman was not looking at her? Where has she learned this social contingency? Through observation, imitation and perspective taking.

Children diagnosed with autism invariably experience difficulties with social skills (McConell, 2002). From an early age children diagnosed with autism find it challenging to initiate and maintain social interactions with peers and adults. This impairment in social interaction in one of criteria used to diagnose autism ( American Psychiatric Association, 2000).

Important social skills that a child with autism should know are:

1) Conversational skills ( commenting, asking questions, imitating, initiating conversation, joining in)
2) Co-operative social behaviors (helping others, including others, following directions/rules)
3) Non-verbal skills (giving/receiving affection, smiling, Identifying emotions)
4) Pivotal behaviors ( eye contact, joint attention, perspective taking, empathy)
5) Play skills (turn taking, sharing, sportsmanship, pretend play)

Every social skill intervention used should be individualized to a child's needs. If a child has limited verbal repertoire, perhaps it will be more useful to teach you child eye contact, smiling appropriately, getting attention appropriately, sharing, joint attention, empathy, helping other, waiting, etc. If your child has significant language, social interaction can be more focused on play, sharing, joint attention, sportsmanship, etc. For the next few days, I will be discussing each component of social interaction and will be giving you an overview on how to teach your child specific skills based on your child's verbal repertoire.

Any comments and questions are welcome !

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Little Steps | 

More than words..

Language  is a very complex skills. Applying language to a social context is even more difficult. For a child with autism, initiating conversation is challenging. This is because they have a language deficit and a social deficit. In other words, children diagnosed with autism have not contacted the reinforcing qualities to engage in a conversation.

In general, children with autism find it more reinforcing to engage in self-stimulatory and repetitive behaviors such as spinning a toy non-contextually, engaging in body rocking, hand-flapping etc. Because of this, teaching your child appropriate language and behavior is so important. We want to help our children look more like their peers and engage in social behavior just like how we do.

In addition, some children diagnosed with autism have a limited verbal repertoire and some children are non-verbal. These children have a long history of gesturing for what they want when they want it. And guess what we do as parents and teachers? We give them access to these things as soon as they gesture for it. What's wrong with this? The problem here is that your child is learning that his/her gestures are getting him/her access to what they want. Therefore, why talk when I can tug at your hand and show you what I want?

Parents always have a concern that their child has had a long history of gesturing. Thus, if they change their behavior, they are afraid their child will engage in tantrum behavior. So parents want to avoid that and "give in". So what do we do now? How does a parent prevent "giving in"?

1) Don't be afraid: You are your child's number one advocate. You are the only person that can teach your child what is appropriate and what is not. I always ask parents this " What if your child was not diagnosed with autism? Will you be teaching him appropriate behavior?" and the answer I always get is "yes". So my rationale is that autism or no autism, you child is capable of learning. He/she deserves the right to learn and this requires you to be a warrior. A warrior is someone who is brave and not afraid to address change. Therefore, don't be afraid. You are a warrior and you can do this. :)

2) Magnify teaching and start small:  If your child is non-verbal or has limited language repertoire, start small. We do not want to frustrate our child and make language punishing. The first steps to teaching language is to teach small sounds that you know they can make. Some example are "m," "aah," "oo," etc.

3)  Now we will use "incidental teaching" to teach language. Incidental teaching is defined as a method for increasing expressive language by observing what your child initiates for in their environment and we are required to respond in a way that requires language or more language from your child.

Here are the steps we will use:

• The child initiates
• We ask the child to elaborate & prevents access to the item
• The child eloborates
• The child gains access to what he/she wants

Here is an example:

• The child initiates for a cookie by gesturing
• The adult looks at the child and request an elaboration  "cookie" & prevents access to the item
• The child says "cookie"
• The child gains access to the cookie

Initially, your child might engage in tantrum behavior or other behaviors of concern, so when this happens, remember to lower the expectation for your child.  By doing this, you are setting your child up for success. Do not give your child access to any preferred item when he/she is engaging in tantrum behavior. This is very important. You do not want to teach your child that when your child engages in inappropriate behavior, he/she will gain access to the preferred item.

So this is a suggestion as to what you do if and when your child is engaging in tantrum behavior.

• The child initiates for a cookie by gesturing
• The adult looks at the child and request an eloboration "cookie"
• The child tantrums or starts crying

At this point, go back to a word or sound that your child knows, say "coo" or "o". If your child is still engaging in tantrum behavior, do not let your child escape this situation. Wait till your child is quiet or is not engaging in tantrum behavior, offer your the cookie again and expect only eye contact. When eye contact is given, give him/her access to a small piece of cookie. Remember, he/she only gains access to the whole cookie when he/her emits a sound or language. Also, remember WE DO NOT WANT TO PUNISH LANGUAGE.  Now, if your child has been engaging in tantrum behavior for awhile, but now has calmed down and has given you eye contact and gained access to the small piece of cookie, let him/her go play for awhile come back to teaching later.

The next initiation for the cookie, expect language even if it is a sound, and when your child finally emits the sound/language, give him/her that whole cookie and celebrate that success ( give him two cookies if you'd like!)  You always want to end with success and you want to make it clear to your child the expectations you have for him/her. You do not want to punish learning or language. Always keep that in mind. Start small and build up on that, so your child can be successful.

Raise the bar when you observe an environment  that is going to co-operate with you and lower the bar when you observe that the environment is not co-operating with you.

Practice makes perfect, therefore with more practice, learning occurs more frequently and your child is slowly learning a new repertoire of behavior.

You can use incidental teaching for learners that are more sophisticated in acquiring language. Here's an example of that: 

• The child initiates for a cookie by saying "I want cookie"
• The adult looks at the child and request more language  "Mommy, can I have a cookie please?" & prevents access to the cookie
• The child says "Mommy, can I have a cookie please?"
• The child gains access to the cookie

Remember, language is an important part of our life and we want to continue teaching our children language daily and keep embedding it in their behavior repertoire. Be your child's language warrior and you will see with the right contingencies, your child will start learning what they are supposed to be learning. Last but not least, I can't stress this enough, make learning fun. This is something new your child is going to be doing and the last thing you want is to make learning  language feel like a challenging process. 

I hope this was not too much information for you, if you have any questions, please leave a comment and I will try my best to help as much as I can. Thank you !!






 

Little Steps Malaysia & Workshop

Hey everyone !! it's getting very close to the early bird price which is MYR 100. So if you are  attending please email me at littlestepsmalaysia@gmail.com in order to sign up for the special price, that will be great.

Wanted to give everyone an idea of the services Little Steps Malaysia provides to children with autism:

1) Individualized programming and consultation based on your child's needs
2) Provide training to parents using the science of ABA
3) Setting up the individualized programs at home for your child
4) Help parents troubleshoot behaviors of concern
5) Improving behaviors
6) Creating a positive and fun learning environment for children
7) Increasing independence at home

The services we provide are all individualized and tailored to your child's needs. Our objective at Little Steps is to give parents the relevant tools to help parents help their child achieve their full potential. We follow the seven dimensions of Applied Behavior Analysis in order to make programming at home effective.

Little Steps Malaysia is dedicated to all the children diagnosed with autism. We believe that every child diagnosed with autism deserves the chance to grow into their full potential. We believe children with autism can do anything they set their heart to do and most importantly we always operate by having the child's best interest in mind.

If you are interested to learn more, please call me at 010-221 4028, email me at: littlestepsmalaysia@gmail.com or come to the workshop ! :) Hope to hear from you soon !!

The way we operate

During my time in Malaysia, I have been asked this question " What ABA model do you operate from?- is it Lovaas? is it the UCLA model?  is it the early autism partnership model?"

I am very confused by this. I guess my confusion lies here: Applied Behavior Analysis is a science, shouldn't a form of science be the same thing? Shouldn't we all operate from the same model just like any other form of science?

Of course I understand having worked at a PCDI dissemination site, we utilized the technology of activity schedules widely ( the founders of the school created the technology of activity schedules.)  However, we still operate from the science of Applied Behavior Analysis. We still operate from a technology that has shown reliable, valid and evidence based results that are effective.

Lovaas, Sunberg, Jack Michael, Brian Iwata, and Thomas Freeman are all scientist that have studied the literature extensively, conducted research, published research and reported their findings. All of them have contributed to the field of ABA widely. Just like any other scientist that studies specific things in molecular biology , these scientist have also concentrated in the research of specific things as well. For example, Dr. Ivar Lovaas he was an amazing and knowledgeable man, the Lovaas approach states clearly that it is based on the science of Applied Behavior Analysis.  Dr Lovaas, focused more on incidental teaching in the child's natural environment and discrete trial teaching. But if you go on the website and read more, he envelopes the science of applied behavior analysis in his implementation of ABA. The Lovaas approach does use prompting strategies, functional communications, etc.Another example, Jack Michael, he concentrates his research on verbal behavior and Iwata researches on the functions of behavior. This does not mean we primary should follow their model of reported findings and just do what they do specifically. This means, we learn from what they have learned and try to replicate their findings if need be, using all the technology that we have in place based on ABA. Lovaas has contributed so much to the the field and his work is being replicated everywhere in great ABA programs. So what does this all mean? What should an ABA program look like? A great ABA program does not follow any specific model, it does not use just some strategies, and it must be individualized to the child's current needs. A good ABA program follows the science of Applied Behavior Analysis.

Therefore, when asked these days what model I follow, I try to be respectful enough and say I don't. However, we do follow the science of Applied Behavior Analysis and any program implementing teaching procedures using ABA should follow and be committed to the 'Seven dimensions of Applied Behavior Analysis' ( Baer, Wolf, and Risley, 1968).

The dimensions are:

1) Applied: this means that when choosing a behavior, the behavior chosen should be socially significant and have socially valid importance to the individual

2) Behavioral: behavior that is chosen should be measurable and documents that is was the individual behavior that was changed.

3) Analytic: a functional relation should be demonstrated. In other words, the intervention chosen should show experimental control over the occurrence and non-occurrence of the behavior.

4) Technological: the written procedures in the individualized program for the child or the written description of the procedures in a study should be written clearly so that others can understand it and replicate it.

5) Conceptually systematic: all the interventions that are being used should be derived from the basic principles of behavior.

6) Effective: The intervention chosen  or the program chosen for your child should improve behavior to produce pratical results for your child.

7) Generality: the intervention produces behavior that we can see across different environments and spread to other behaviors. Your child behavior should generalize to different settings, people and materials.


The seven dimensions should serve as the primary "model" when evaluating a good ABA program.
There should not be any other "model". There should always be great science in ABA and only then will your child benefit fully.

I hope this helps you pick a good ABA program for your child.

As usual, email me with questions if any :)

One step at a time...

Before starting any ABA intervention with your child, it's good to have a mind set. It's good to have a mantra to tell yourself in order to be grounded and in order to never give up. It's always good to hold on to a set of rules for yourself.

The first rule:

1)  Learning always has to be magnified

Autism affects each child differently. Each child learns differently. Therefore, based on your child's skills, learning should always be magnified. All those little steps you teach should be reinforced leading up to the final step of learning. For example: If your child can only say a few sounds, don't teach your child a sentence. First teach him sounds that you think would be important for him to know in order for him to communicate. Then, build on those sounds to eventually make words. Once he has words in his repertoire, build up to a two word sentence, a three word sentence and so on. With any skill you teach your child, you want your child to be motivated to learn. If you are teaching too much too soon, the teaching interaction might become punishing, and your child would not be motivated to learn.

2) We have to build on behavior that is already in the child's repertoire

Just like the previous example, don't teach your child to talk in sentences, when your child is finding it challenging to produce a sound or even imitate what you model. First build on imitation of sounds he knows, then build those sounds into words, sentences and so on. Shaping procedures are great for this and I will write more on shaping soon !

3) Only teach observable behavior

During my time in Malaysia, I have heard many say "it boosted his confidence" or "it makes him happy, that's why he flaps his hands". These opinions are merely assumptions. We do not know if it really makes him happy or if it does boost his confidence. It may, but we can't measure happiness and certainly can't measure confidence. What you can measure is the duration your child is engaged independently in his schedule, the number of times your child engaged in head banging, the variety of awesome food your child is consuming and because you have taught him appropriate social interaction, the number of times your child initiates for hugs. This is the hardest task for a parent. I can't imagine because I do not have kids of my own. But if I did, I imagine this part will be the hardest and the most difficult emotionally. However, seeing behavior in observable terms, helps you become a better teacher for your child. It helps you make good decisions and teach appropriate behavior so your child can become more independent and look more like his/her peers.

Now finally, the mantra that a parent should follow is this "Magnify and teach observable behavior so learning is fun".

Key words: Magnify, Teach, Observable = FUN.

Teaching your child should be a really fun process. It should be a time where you and your child spend together and learn things from each other. Your child should be motivated to learn, and you should be motivated to teach. Teaching should never be a struggle. It should always be a shaping process. It should always be little steps at a time...

What is Autism?

Autism is defined behaviorally by symptoms that appear prior to age 3. According to the Diagnostic Statistical Manual ( IV) the criteria for diagnosing Autism are abnormal or delayed development in 3 areas:

1) Impairment and delays in Social Interaction (Social Skills)
2) Qualitative impairment and delays in communication ( Language)
3) Restrictive, repetitive and stereotyped patterns in behavior ( Behavior Repertoire)

Under these three categories there are sub categories as described below. In order to meet the criteria for autism, there has to be a total of of six (or more) items from (1), (2), and
(3), with at least two from (1), and one each from (2) and (3):

A total of 6 or more items is required to meet the criteria for Autism in

 1) Impairment and delays in Social Interaction (Social Skills) ( at least 2 from this category)

(a) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze,
facial expression, body postures, and gestures to regulate social interaction (e.g., not reponding to name everytime her/his name is called, does not make eye contact)

(b) failure to develop peer relationships appropriate to developmental level. (e.g., your child tends to play by himself/herself in a situation where there are other children present or engage in tantrum behavior when peers initiate play)

(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other
people (e.g., by a lack of showing, bringing,lack in joint attention, or pointing out objects of interest)

(d) lack of social or emotional reciprocity (e.g., does not like hug, tickles, or show empathy when another child is crying)


 2) Qualitative impairment and delays in communication ( Language) (at least 1 from this category)

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt
to compensate through alternative modes of communication such as gesture or mime)

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a
conversation with others

(c) stereotyped and repetitive use of language or idiosyncratic language (e.g., saying the same word, scripting from movies, making unusual sounds)

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to
developmental level


3) Restrictive, repetitive and stereotyped patterns in behavior ( Behavior Repertoire) (at least 1 from this category)

(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that
is abnormal either in intensity or focus (e.g., lining up objects, spinning object in the same way, not playing with toys appropriately)

(b) apparently inflexible adherence to specific, nonfunctional routines or rituals (e.g., engages in tantrum behavior when going from one place to the next)

(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex
whole-body movements)

(d) persistent preoccupation with parts of objects (e.g., constantly playing with the same toy in the same way)

If you read this and think your child has autism, please contact your local pediatrician immediately. Your pediatrician can refer you to someone who can conduct a formal assessment and refer you to a provider that can provide effective treatment. The earlier intervention is sought, the more likely your child will improve. There is no cure for autism but with effective treatment and intervention, your child's autism can improve and in some cases the diagnosis can be taken away.

In choosing a treatment, feel empowered as a parent to take your time and do some research to see what is out there. Like I always say, the best treatments are the ones that report all their outcomes and evidence. Some treatments do report outcomes and evidence but they may not be socially valid, reliable or make any behavior improvements over time.

Please make yourself aware and be aware of fad treatments. Fad treatments claim to "Cure" autism and make your child better. Till date, there is no known cause for autism. There is no cure for autism. Choosing an effective program that is based on improving behavior is they way to go. I hope you feel empowered as a parent to make valid and reliable decisions on a treatment.

Here are two great links to help you think about some treatments out there and also links to help you with your questions on vaccinations, gluten free diets, etc

A Parent's Guide to Autism Spectrum Disorders

Suggested Links to Research Studies 

Vaccinations and Autism

Gluten and Casein Free Diets & Autism

Malaysian Parent Support Group