Wednesday, September 14, 2011

Independence and Resposibility... that's what we're working towards.

I just had to post this because I am so happy! One of the skills we're working on with E is resposibility. Her glasses is her responsibility and she must wear them whenever she's at school, reading, doing homework, while watching televesion and during therapy sessions. It has been a long road in getting her used to wearing her glasses. She has had sensory issues in the past with not wanting anything on her face. But we worked on it and every session she is told to wear her glasses. Mom and dad have also been proactive in telling her to wear her glasses during the appropriate times. And today... well today I showed up and she was already wearing her glasses. And according to mom, she didn't even have to tell her to put them on. Yaaay E!

Wednesday, August 24, 2011

A bit of advice for parents...

I know I've blogged about not wanting to give advice or suggestions on this blog because I want to just blog about my experiences. But I've had several parents (parents of children with Autism and parents of "normal abled" children) ask me about confronting challenging behaviors. So here is what I usually tell them...

Behaviors occur for a reason. In order to better understand the behavior, you must first figure out what caused the behavior. For example, a child screaming and crying at the grocery store because mom would not let her have candy. The cause of the behavior is obvious, she wanted candy and couldn't have it. So the screaming and crying occured (the behavior). Therefore, the consequence is that now, mom is frustrated and therefore gives in and gives the child the candy. The next time mom and child visit the store, the same behavior occurs. What I tell parents, is that they are unknowingly reinforcing that challenging behavior by giving in and giving the candy. Because, let's think about it in the child's point of view... I want candy... mom won't let me have candy... so I will cry and scream and mom will eventually give me the candy. There, mom has unknowingly reinforced the challenging behavior.

My advice to parents is that if you know this behavior will most likely occur, talk to your child prior to going out. While still at the house, or in the car, let your child know what is expected of them. Tell your child how you want him/her to behave while in the store. And parents this is important... you might still have to give them candy. But instead of rewarding the challenging behavior, reward the good (expected) behavior. So if necessary, tell your child if he/she behaves while at the store, he/she may have a piece of candy. And the most important part of this is for parents to FOLLOW THROUGH. Which means if your child does not display the appropriate behavior, then you must deal with behavior that will most likely occur when he/she does not get the candy. Behaviors will most likely increase because your child will not be used to this type of response from you. But have faith that the intervention will work.

Friday, August 12, 2011

Great Game for teaching skills.

This is one of my favorite games to use during therapy sessions.


It helps me with so many programs.
It helps with fine motor skills. Here my client is putting the pieces of "ice" together. It also helps with "Requesting for Attention" because she must say "Excuse me" to gain my attention, and FCT (Functional Communication Training) because she needs to say "I need help" when she needs my assistance.





It's a fun game that does not require any reading. It is useful in Interactive Play because it teaches "Taking Turns." It also fosters complex thinking skills. The object of the game is to make sure the player chooses a piece of "ice" to hammer that will not make the bear fall.













Tuesday, July 26, 2011

High functioning client keeps me on my toes!

People always ask me if working with higher funtioning children with Autism is easier. I always give the answer of "yes and no." I have a 4 year old client who is higher functioning, which means that as far as skills she has many. Her issues are mainly social and behavioral in nature. The skills that we work on are mainly everyday social skills such as greeting people, requesting attention, and proper conversation skills. One of the skills that she needs work on is greeting other children. We work on this sometimes at the park or playground. I have to be "quick on my toes" because each time I give her a reason as to why it is important to be able to greet and talk to other children, she always has an excuse as to why she doesn't think this skill is necessary. For example, before we practiced the skill (going up to a child and saying "Excuse me, Hi"), I explained to her that saying "hi" to other kids is a good way to make friends. And this was the exchange that occured...

Client: "I have friends and I didn't say "hi" to them."
Me: "Well they said "hi" to you and that's how you became their friend."
Client: "Then I don't have to say "hi", just wait for them to say "hi" to me."
Me: "Yes, you can do that, but it would be nice if you can say "hi" first."
Client: "No, it will not be nice."
Me: "Why not"
Client: "Because I have to say "hi" and I don't want to say "hi" so it will not be nice for me."
Me: "Oh, I see." (At this point I am having to think of another way to respond in a way that she cannot argue with.)

Therefore, I realized that she will need a reinforcer to be motivated to complete the task. The reinforcer (ice cream) worked and she was able to say "hi" to three kids. The ultimate goal is for this skill to be generalized, but for now I can see that she will need a good reinforcer to complete this task.

Friday, July 15, 2011

The Premack principle... parents use it all the time... and it works!

"Premack's principle (Premack, 1959, 1963) states that more probable behaviors will reinforce less probable behaviors. The principle was derived from a study of Cebus monkeys by Professor David Premack, but has explanatory and predictive power when applied to humans. This is evidenced by the fact that therapists use the principle in behavior modification. Premack's Principle suggests that if a person wants to perform a given activity, the person will perform a less desirable activity to get at the more desirable activity. In behaviorist terms, activities become reinforcers. Students will be more motivated to perform a particular activity if they know that they will be able to partake of a more desirable activity as a consequence. If high-probability behaviors (more desirable behaviors) are made contingent upon lower-probability behaviors (less desirable behaviors), then the lower-probability behaviors are more likely to occur. More desirable behaviors are those students spend more time doing if permitted; less desirable behaviors are those students spend less time doing when free to act." (Wikipedia)

As a therapist I utilize the Premack principle with my clients all the time. But not just on my clients, but also with my ten year old daughter. It is a useful parenting tool. For example, I tell my daughter that if she reads for 30 minutes each day, then she may go on the computer for 1 hour. This works so well that she will read everyday for 30 minutes without being prompted. I tell client's parents that this is a good tool because it follows the concept of positive reinforcement.

Monday, July 11, 2011

Functional Behavioral Assessments:

Interesting article... to read the rest, go to the link: http://www.wrightslaw.com/info/discipl.fab.starin.htm

Functional Behavioral Assessments:
What, Why, When, Where, and Who?
by
Stephen Starin, Ph.D.

The recent amendments to IDEA are final. School districts are now required to conduct functional behavioral analyses of problem behaviors, under certain circumstances.

Friday, July 8, 2011

DTT and Parents

Today, I introduced Discrete Trial Training to a client's mother. In the past this mother has questioned DTT and whether it is actually doing any good. Therefore, today I decided that she should learn more about it. With a brief explanation on the procedures, I let her run a few programs. She did really well. I showed her how to correct and to give praise. Of course I took the data, but she was in control of the programs. After she was done, she commented that it was great to see her daughter answer correctly. I was happy to hear that from her. I took the chance to educate her on the purpose of the programs. My hope is that she is now more "on board" with all of the programs. She has been skeptical due to the fact that she has had services with other companies and had been unhappy with the results. Therefore, her concerns were valid. But I hope now, she understands the process and will have more faith that it will yield results.

For a brief explanation on DTT: http://www.autismtreatment.info/what%20is%20a%20discrete%20trial.aspx

Tuesday, July 5, 2011

Kids say the darndest things.

A fellow therapist who covered a session for me left the oddest note for me. The note read... "Questioned E (I will refer to client as E) regarding her answer to "What makes Jeannie Happy?" because her answer was "When I bring her her shoes." However, I was not able to get a real answer as to whether or not this really does happen."

So I thought to myself how odd and "Oh no! A fellow therapist thinks I kick back in this client's house with my shoes off (which we are not supposed to do unless the client's parents request it).

And so when I inquired E as to why she said that, her answer was "I don't know." And so I asked her if she knew what the statement "I bring her her shoes" meant. And she said yes. So I explained to her that this statement is not true because I do not take my shoes off when I am in her house. She thought about it and she said "ok."

And then we came to the Emotions program where I ask her that question "What makes (x) happy?" (x is anyone of importance in her day to day activities). I asked her "What makes teacher Ortencia happy?" (her GenEd teacher) and wouldn't you know it her answer was... "When I bring her her shoes." I almost let out a huge laugh, but fortunately I held it in. Needless to say I had to alter that program a bit by telling her she can no longer say "When I bring her her shoes."

Monday, July 4, 2011

Happy 4th of July, but to some parents of children with Autism it's a nightmare!

One of client's mom expressed her concern regarding the fireworks on the 4th of July. Her older son is extremely sensitive to certain sounds including dogs barking, cars, and fireworks. I told her that a lot of children are sensitive to the loud sounds of fireworks. She then explained to me that the severity of the behavior that he displays when he hears the fireworks. He will slam all doors shut, shut all windows, and start screaming and crying. I asked her what interventions she has tried in the past. She said that she has tried putting head phones on his ear. However, he also has sensitivity to touch and so the pressure of head phones really bothered him. So two weeks ago we started introducing the head phones. The first day we started with having him put the head phones on his ear for 5 seconds. We used our fingers as a visual for him to see when the 5 seconds was over. We used a really good reinforcer, his gameboy and utilizing the premack principal. It was a success right from the beginning. I told mom to follow the procedure each time he asks for his gameboy. And each time to increase the time by 10 seconds. And by the third day have him wear the headphones for 1 minute. And by the 5th day have him wear for 5 minutes but this time allow him to play with his gameboy with the headphones pugged into the game. And by the next week have him wear the headphones whenever he wants to play with his gameboy.

I called mom today to check up and see how it's working so far. And good news... her son is now wearing the headphones whenever he plays with his gameboy. Therefore I told her that on 4th of July, allow him to wear the headphones during the fireworks. But I explained to her that this is a temporary solution. She will eventually have to take off the headphones. But try to keep them on as long as possible to at least give her a break from the behaviors.

As a side note, I am not usually her son's therapist. I am her daughter's therapist, but I felt for her when she was explaining the situation to me. So I stayed for 30 minutes after my regular session to work with her son. Her son has been approved for services, but has not started yet.

Friday, July 1, 2011

Token System... changing it up.

I had a somewhat difficult start to my session with a client today. This client whom I will refer to as "C" is familiar with the "token system." The token system is a reward system in which the child receives a "token" for completing a task. The token can be anything that has value for the child (e.g stickers, play money, puzzle pieces, etc.). In C's case it was stars. I will usually attach a task to each star randomly, and C will need to get 5 stars in order to get a small break in which he can play a board game. This system has not been working as well as usual and so today I decided I needed to change it. I thought that maybe working for 5 stars was just too much. I needed a way to continue to achieve the same results without C having to work for so many stars.


And so what I thought was, maybe he needed to see right from the beginning the reason why he was getting a star. I also made it seem easier by having him work for 2 stars instead of 5, which I think is the reason for his high non compliance at the beginning of the session. And I attached a task for each and put it on the paper (my drawing skills are not so great)so he gets a visual.


The drawing means that C will stay seated the entire time and the 1 2 3 (with Xs through them) is how many programs he needs to finish. This worked well for me today and needless to say, I was very happy. C was also happy because he is able to visualize exactly what he needs to do to get the stars and to him 2 stars is easier to get than 5 stars.

Here's information regarding Token System/Token Economy...

http://www.kidsmakingchange.com/TokenEconomy/cms/Token_Economy.html

Thursday, June 30, 2011

CrayAngles... awesome idea!

I was at lunch with my daughter and my hubby the other day and the waitress gave my daughter these crayons.


And I thought what a great idea. I don't know where I've been, but that was the first time that I've seen crayons shaped like triangles. I know for me, these crayons will come in handy for at least one of my clients. The shape prevents them from rolling off the table. And the shape actually feels good in your hand. I'm excited about trying these out during my session.

Wednesday, June 29, 2011

So here it is...

I'm starting this blog by saying that although I am considered a professional in my field, by no means do I know everything. I have a lot to learn and am learning everyday. I learn not only from other professionals, but also from my clients and their parents. I am often asked by parents whether or not I think their children will ever communicate, read, play with other children, ride a bike, drive a car, etc. And what I often tell them is that I cannot foresee the future. But that I promise to do my job to the best of my ability. And all that I ask of them is to have faith and to do the work that is necessary.